Guideline-Recommended Changes to DMARDs Lead to Quicker RA Remission

Adjusting disease-modifying antirheumatic drugs (DMARDs) within 90 days was associated with shorter time to low disease activity or remission (LDAS) among patients with rheumatoid arthritis (RA), according to the findings of a recent study.

Current guidelines recommend adjusting DMARD therapy every 3 months for patients with RA with moderate to high disease activity (MHDAS) until patients achieve LDAS. However, little is known about how quickly patients with RA adjust therapy and how that timing affects disease activity.
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For their study, the researchers identified 538 patients with RA and MHDAS who were enrolled in the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Research (RACER) registry. They used Cox regression to assess the association between DMARD therapy adjustment and time to LDAS.

Overall, 60% of patients with persistent MHDAS had adjusted DMARD therapy within 90 days. The overall median time to DMARD adjustment was 154 days and to LDAS was 301 days.

Patients who were older, had lower baseline disease activity, had longer duration of RA, or had used biologics were significantly more likely to experience longer times to DMARD therapy adjustment.

In addition, patients with higher baseline disease activity, who were African-American, or who did not have DMARD therapy adjusted within 90 days were more likely to experience longer times to LDAS. 

“Adjusting DMARDs within 90 days was associated with shorter times to LDAS, but many patients with persistent MHDAS waited more than 90 days to adjust DMARDs,” the researchers concluded. “Interventions are needed to address the timeliness of DMARD adjustments for RA patients with MHDAS.”

—Melissa Weiss

Reference:

Shaw Y, Chang CCH, Levesque MC, Donohue JM, Michaud K, Roberts MS. Timing and impact of decisions to adjust disease-modifying antirheumatic drug therapy for rheumatoid arthritis patients with active disease [published online September 21, 2017]. Arthritis Care Res. doi:10.1002/acr.23418.