Older, Asian patients less likely to receive b/ts DMARDs for rheumatoid arthritis
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Key takeaways:
- Demographic factors were significantly associated with slower or faster initiation of b/ts DMARDs for RA.
- Disparities persisted despite fully funded access to drugs based on clinical need under the NHS.
Patients with rheumatoid arthritis aged younger than 40 years are more than twice as likely to receive biologic or targeted synthetic disease-modifying anti-rheumatic drugs vs. older individuals, according to data.
The study, based in England and Wales and published in The Lancet Rheumatology, additionally found that Asian patients were almost half as likely to receive biologic or targeted synthetic DMARDs for RA, compared with white patients.
“Biologic and targeted synthetic DMARDs (b/tsDMARDs) have been transformative in the management of rheumatoid arthritis,” Mark D. Russell, PhD, of the Center for Rheumatic Diseases at King’s College London, told Healio. “Despite this, there is surprisingly little published data on what proportion of patients get escalated to biologic or targeted synthetic DMARDs and what influences the decision to commence biologic or targeted synthetic DMARDs.
“We wanted to explore this in detail using one of the incredible datasets we have available in the United Kingdom — the National Early Inflammatory Arthritis Audit,” he added.
To determine how biologic or targeted synthetic DMARDs use varies across patient populations, including individuals of different ages and ethnicities, Russell and colleagues conducted an observational cohort study of 6,098 patients with RA (mean age, 59.2 years; 64.2% women) who enrolled in the National Early Inflammatory Arthritis Audit between May 8, 2018, and April 30, 2022.
The researchers used modified Poisson regression to evaluate whether demographic factors, smoking status or comorbidities had any link to the initiation of a biologic or targeted synthetic DMARD for RA within 12 months of an initial rheumatology appointment.
According to the researchers, patients aged younger than 40 years were more than twice as likely to be initiated on biologic or targeted synthetic DMARDs vs. older patients (adjusted RR = 2.41; 95% CI, 1.83-3.19). Meanwhile, compared with white patients, Asian patients were almost half as likely to be initiated (adjusted RR = 0.52; 95% CI, 0.36-0.76), while Black patients were more likely (adjusted RR = 1.54; 95% CI, 1.1-2.16).
The higher likelihood for initiation among Black patients was “at least partly explained by greater disease severity at baseline,” according to the researchers. Meanwhile, disparities among Asian patients were evident only among Asian women, and had no relation to socioeconomic status, baseline disease severity or initial response to conventional synthetic DMARDs, Russell and colleagues added.
“England and Wales have a universal health care system — the National Health Service — where individuals who meet defined criteria can receive fully funded access to biologic or targeted synthetic DMARDs,” Russell said. “Despite this, we saw marked variation in who gets started on biologic or targeted synthetic DMARDs for RA. These findings suggest that we need to move beyond a one-size-fits-all approach and tailor the information we provide to patients when considering biologic or targeted synthetic DMARD initiation.
In our study, we were unable to explore the influence of individual patient choice on whether or not to commence biologic or targeted synthetic DMARDs,” he added. “To better understand this, a mixed methods approach would be valuable, incorporating qualitative research, such as interviews and surveys. This would help us to better understand why there are such disparities in who gets commenced on biologic or targeted synthetic DMARDs, despite nationally set funding criteria.”
For more information:
Mark D. Russell, PhD, can be reached at mark.russell@kcl.ac.uk.
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