Rheumatology Advance Access originally published online on May 22, 2008
Rheumatology 2008 47(7):1061-1064; doi:10.1093/rheumatology/ken193
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Changing patterns of medication use in patients with rheumatoid arthritis in a Medicaid population
1Department of Preventive Medicine, 2Department of Medicine, Vanderbilt University School of Medicine, 3The Mid-South Geriatric Research Education and Clinical Center and 4Clinical Research Center of Excellence, VA Tennessee Valley Health Care System, Nashville, TN, USA.
Correspondence to: C. G. Grijalva, Department of Preventive Medicine, Vanderbilt University School of Medicine, 1500 21st Avenue, 2600 VAV, Nashville, TN 37212, USA. E-mail: carlos.grijalva{at}vanderbilt.edu
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Abstract |
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Objective. To examine changes in patterns of medication utilization in patients with RA.
Methods. Data from Tennessee Medicaid (TennCare) databases (1995–2004) were used to identify adults with both a diagnosis of RA and at least one DMARD prescription each year. Annual age-specific utilization of DMARDs, glucocorticoids, NSAIDs and narcotics was measured on the last day of each year to determine the point prevalence of use of these agents.
Results. Records from 23 342 patients with treated RA were analysed. Most patients were females (78%) and white (74%). The median age was 57 yrs (interquartile range: 48–65). The proportion of patients who had a current DMARD prescription on the index date increased from 62% in 1995 to 71% in 2004 (P < 0.001). MTX was the most commonly used DMARD. By the end of 2004, 22% of patients had a current prescription for a biologic, and etanercept represented 51% of all biologic therapies. During the study period, the overall utilization of glucocorticoids decreased from 46% to 38% (P < 0.001), whereas NSAID utilization increased from 33% to 38% (P < 0.001), and use of narcotics increased from 38% to 55% (P < 0.001). A secondary analysis that identified RA patients based on diagnosis codes alone, showed similar patterns, but lower DMARD utilization which increased from 33% to 52% overall and from 0% to 16% for biologics.
Conclusions. The utilization of DMARDs increased in TennCare patients with RA, and by 2004, use of biologics was substantial. Although glucocorticoid utilization decreased, use of both NSAIDs and narcotics increased.
KEY WORDS: Rheumatoid arthritis, Disease modifying anti-rheumatic drugs, Epidemiology
Submitted 3 January 2008;
revised version accepted 14 April 2008.
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