Biologic agent, methotrexate use rose significantly among veterans with RA

WASHINGTON — The use of biologic agents in treating rheumatoid arthritis has increased markedly during the last decade, with significant use of methotrexate as the first-line agent, according to research presented at the American College of Rheumatology Annual Meeting.

Researchers reviewed Veterans Affairs’ national databases from 2000 through 2009 to study 13,254 patients with rheumatoid arthritis (RA). They examined dosing trends in methotrexate (MTX) and usage of traditional disease-modifying antirheumatic drugs (DMARDs).

Bernard Ng

“There are many studies going on advocating the increased use of methotrexate at a higher dose,” researcher Bernard Ng, MBBS, FRCP, assistant professor at Baylor College of Medicine and director of rheumatology clinical services at Michael E. DeBakey Veterans Affairs Medical Center in Houston, told Healio.com. “These are all clinical trials. We wanted to see if the clinical trials and the recommendations from various experts [translated] into an actual trend of change that we can see in clinical practice.”

Among the cohort, biologics use increased from 2.8% in 2000-2001 to 18.9% in 2008-2009, with etanercept being the primary biologic available between 2000 and 2001. After its introduction in 2003, adalimumab became the most common biologic agent in the cohort (48.5%) by 2008-2009. MTX as the first DMARD/biologic used in DMARD-naive patients increased from 39.8% to 52.1% during the study period, while hydroxychloroquine and sulfasalazine showed gradual decline.

During the study, biologic use as first-line agents remained relatively unchanged at 1.3% to 3.6%. Of the patients, 52.9% had been on MTX monotherapy for 90 days or more, with a mean MTX start dose increase of 10.1 mg per week to 11.4 mg per week between 2001-2002 and 2008-2009 (P<.01). Patients who were started on less than 10 mg MTX weekly decreased from 43.2% to 22.1% (P<.01). The mean maximum MTX dose attained increased from 15.6 mg per week to 17.8 mg per week during the study (P<.01).

“The average maximum dose at the end of our study is still considered low compared with current standards,” the researchers concluded.

The results “give reassurance that we are actually in the daily clinical practice following what the clinical trial recommendations are,” Ng said. “It could follow it a little more rapidly. … It takes time for people to adopt and get comfortable with what is recommended.”

Disclosure: Dr. Ng has received consulting fees or other remuneration from UCB Pharmaceuticals.

For more information:

Ng B. P1838: 10-Year Trends in the Use of Disease Modifying Anti-Rheumatic Drugs (DMARDs) and Biologic Agents in Rheumatoid Arthritis: A National Veterans Affairs Study. Presented at: American College of Rheumatology 2012 Annual Meeting; Nov. 10-14, Washington.