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Low-income, elderly RA patients stopped DMARDs because of side effects, safety
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Low-income, elderly patients with rheumatoid arthritis reported side effects or safety concerns as primary reasons for stopping disease-modifying antirheumatic drug therapy, according to recent study results.
Researchers in Boston conducted telephone interviews with 86 people (mean age, 80 years; 89.5% women) who had two diagnoses of rheumatoid arthritis (RA) at least 7 days apart and no disease-modifying antirheumatic drug (DMARD) prescriptions or rheumatologist visits during the previous 12 months. The participants were enrolled in a large pharmacy benefits program for low-income, elderly patients. Interviews included questions on sociodemographics, disease activity, experiences with DMARDs, and the Modified Health Assessment Questionnaire (MHAQ). Prior DMARD users were compared with never-users.
Average disease duration was 20 years, with a mean MHAQ score of 0.55. Nineteen patients reported previous DMARD use, including methotrexate (n=10) and hydroxychloroquine (n=6). Ten of those patients (52.6%) had discontinued DMARD therapy because of side effects or safety concerns. Inefficacy was the reason for 42.1% of cessations.
Thirty-five never-users (52.2%) reported they had never been offered DMARD therapy by their physicians. Fear of side effects was described by 13 nonusers (19.4%), while 49 nonusers (73.1%) reported no knowledge of the drugs. More severe RA symptoms were described by prior DMARD users compared with never-users.
“Among never-users, most report never discussing or being offered DMARDs, suggesting that an educational gap may deter patients with RA from using them,” the researchers concluded. “We interviewed a sizable group of older, low-income, female adults with RA. This population … reported experiencing symptoms that could likely be alleviated by DMARDs. Lack of information and/or concerns about side effects were major impediments to DMARD use.”
Disclosure: Daniel H. Solomon, MD, MPH, receives salary support from NIH-NIAMS (K24 AR055989 and P60 AR047782).
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