AB0242 Delay in dmard initiation in patients newly diagnosed with rheumatoid arthritis: an analysis of united states military health system beneficiaries. (12th June 2018)

• Record Type: Journal Article
• Authors: Kimsey, L.; Weissman, J.S.; Patel, A.; Drew, A.; Koehlmoos, T.; Sparks, J.A.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 1303
• Page End: 1303
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.3925
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Prompt initiation of disease-modifying antirheumatic drugs (DMARDs) is recommended for patients diagnosed with rheumatoid arthritis (RA) to improve symptoms and prevent disease progression, but treatment delays may still occur. Objectives: To investigate predictors and temporal trends for delay in DMARD initiation among patients with incident RA in the United States. Methods: We performed a longitudinal cohort study using administrative data from the United States military's TRICARE program (2007–2012). TRICARE beneficiaries, who are demographically similar to the US, include active/retired military members, spouses, and dependents and receive care in military or civilian settings. We identified incident RA cases using billing codes and initial DMARD receipt using prescription fill date. We quantified the time between RA presentation and initial DMARD receipt, temporal changes in time to treatment over the study period, and investigated predictors of treatment delay (>90 days) using logistic regression. Results: We identified 16 680 patients with incident RA that were later prescribed DMARDs. Mean age was 47.2 (SD 13.5) years, 77.6% were female, and 76.5% were spouses/dependents of the military sponsor. The mean time from initial RA presentation to first DMARD prescription was 125.3 days (SD 175.4). Over one-third (35.6%) of incident RA patients experienced treatment delay (>90 days between presentation and DMARD receipt). Time to DMARD initiation was shorter in later years of the study (mean 144.7 days in 2007; 109.7 days in 2012). Patients prescribed opioids between RA presentation and initial DMARD receipt had 4-fold increased risk for delay in initial DMARD (OR 4.07, 95% CI 3.78–4.37). Patients prescribed opioids had mean time to DMARD of 212.8 days (SD 207.4) compared to mean of 77.3 days (SD 132.3) for those who did not use opioids (p<0.0001). Use of prescription NSAIDs between initial RA presentation and DMARD initiation was also associated with delay (OR 3.32, 95% CI 3.09–3.57). Men were less likely than women to experience delay (OR 0.89, 95% CI 0.82–0.98). Conclusions: In this large US nationwide study, delays in initial DMARD receipt after incident RA were common but time to treatment improved in later years of the study. Avoiding opioid use may decrease delay in initiating DMARDs during this vulnerable period when pain and disease activity are often most pronounced. Disclosure of Interest: None declared