Delay in initiation of DMARD or anti-inflammatory therapy in patients newly diagnosed with rheumatoid arthritis: An analysis of United States Military Health System TRICARE beneficiaries
Document Type
Article
Publication Date
7-18-2018
Publication Title
Seminars in Arthritis and Rheumatism
DOI
10.1016/j.semarthrit.2018.07.003
Abstract
Objective
To investigate factors associated with delay in initiation of initial disease-modifying antirheumatic drug (DMARD) in patients newly diagnosed with rheumatoid arthritis (RA).
Methods
We performed a retrospective cohort descriptive study using administrative data from the US military's TRICARE program (2007–2012). We identified incident RA cases using billing codes and initial DMARD receipt using prescription fill date. We quantified the time between RA presentation and initial DMARD receipt, evaluated temporal changes in delay over the study period, and investigated predictors of treatment delay (> 90 days) using logistic regression.
Results
We identified 16,680 patients with incident RA that were prescribed DMARDs and mean age was 47.2 (SD 13.5) years. The mean time from initial RA presentation to first DMARD prescription receipt was 125.3days (SD 175.4). Over one-third (35.6%) of incident RA patients initiated DMARD > 90days after presentation. There was less treatment delay in later years of the study (mean days to DMARD of 144.7days in 2007; 109.7days in 2012). Patients prescribed opioids had mean time to DMARD of 212.8days (SD 207.4) compared to mean of 77.3days (SD 132.3) for those who did not use opioids (p < 0.0001). Patients prescribed opioids between RA presentation and initial DMARD receipt were more likely to have delay in initial DMARD (OR 4.07, 95% CI: 3.78–4.37).
Conclusion
In this large US nationwide study, delays in initial DMARD receipt for incident RA were common but time to treatment improved in recent years. While further analysis using clinical data is warranted, these findings suggest that limiting opioid use in patients newly presenting with RA may decrease delay in initiating DMARDs.
Recommended Citation
Kimsey, Linda, Joel Weissman, Avni Patel, Alison Drew, Tracey Koehlmoos, Jeffrey A. Sparks.
2018.
"Delay in initiation of DMARD or anti-inflammatory therapy in patients newly diagnosed with rheumatoid arthritis: An analysis of United States Military Health System TRICARE beneficiaries."
Seminars in Arthritis and Rheumatism, 48 (5): 821-827: Elsevier.
doi: 10.1016/j.semarthrit.2018.07.003 source: https://www.sciencedirect.com/
https://digitalcommons.georgiasouthern.edu/hpmb-facpubs/124
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Comments
Copyright and Open Access: http://sherpa.ac.uk/romeo/search.php?issn=0049-0172