Age, racial gaps in b/tsDMARD use for rheumatoid arthritis show ‘surprising’ stability
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WASHINGTON — Disparities in the use of biologic and targeted synthetic disease-modifying antirheumatic drugs for rheumatoid arthritis, including among older, Black and Asian patients, have not changed in 10 years, according to data.
“We wanted to understand how the RA treatment landscape has shifted over the last decade, especially with the growing use of biologics and targeted synthetic DMARDs, which have brought significant improvements in care,” Jinoos Yazdany, MD, MPH, chief of the division of rheumatology at Zuckerberg San Francisco General Hospital, and the Alice Betts endowed professor of medicine at the University of California, San Francisco, told Healio. “At the same time, we wanted to explore whether certain sociodemographic patterns in the use of these therapies emerged over time.
“While we realized that our methods wouldn’t be able to prove the existence of disparities, we were interested in uncovering trends and suggest areas where further investigation for potential disparities is needed,” added Yazdany, who presented the data at ACR Convergence 2024.
To identify disparity trends in the use of newer treatments for RA, as well as guide future research that may help close those gaps, Yazdany and colleagues analyzed data from 360,162 adults with RA (mean age, 60 years; 77% women; 66% non-Hispanic white) included in the American College of Rheumatology’s national RISE registry. For inclusion, participants had to have two ICD codes for RA documented at least 30 days apart between 2014 and 2023.
The researchers used run chart analysis to show trends in biologic and targeted synthetic DMARD use, and multi-level logistic regression to test the associations with patient characteristics.
Overall, biologic and targeted synthetic DMARD use “slowly” increased across the decade, rising from 37% of individuals in 2014 to nearly half in 2023, according to the researchers.
The most commonly used drugs were abatacept (Orencia, Bristol Myers Squibb) and TNF inhibitors, the latter of which were used by “a vast majority of patients,” Yazdany said. Their popularity despite the availability of other mechanisms implies “that the first biologics to come out have had staying power, possibly due to familiarity, physician comfort, or long-term patient success,” she added.
After adjusting for disease activity, biologic and targeted synthetic DMARD use was less likely among older patients (OR = 0.81; 95% CI, 0.79-0.83) and those living in the highest quintile of the area deprivation index, indicating more socioeconomic deprivation (OR = 0.81; 95% CI, 0.7-0.94). Compared with white individuals, use of these drugs was also less likely among Asian (OR = 0.79; 95% CI, 0.73-0.86) and Black (OR = 0.88; 95% CI, 0.80-0.96) patients.
The persistence of between-group differences was surprising, according to Yazdany.
“We had expected that differences between groups might have narrowed over time, given emerging data about the safety profile of biological drugs in older patients and the strong interest of our clinical community to narrow disparities in drug access,” she said. “It was surprising to see that differences in use over time were stable.”
These trends require further research, she added.
“We need research that takes a deeper dive, including with richer clinical data, patient interviews and rheumatologist interviews, to understand the patterns we are seeing,” Yazdany said. “What explains the lower rates of biologic and targeted synthetic DMARD prescribing among patients who are older, from certain racial and ethnic groups, or who live in areas with lower neighborhood socioeconomic status? This type of research will help us understand whether some of the differences represent health disparities and identify areas that are amenable to intervention.”
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Li J. Abstract #2608. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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