Prescribing practices in a US cohort of rheumatoid arthritis patients before and after publication of the ACR treatment recommendations

PURPOSE: To examine prescribing of biologic and nonbiologic disease-modifying anti-rheumatic drugs (nbDMARDs) in Rheumatoid Arthritis (RA) before and after publication of the American College of Rheumatology (ACR) treatment recommendations. METHODS: We identified biologic naive RA patients cared for by US rheumatologists participating in the CORRONA registry with visits prior to and/or at least 6 months after publication of the ACR recommendations (time periods: 2/02 - 6/08 vs. 12/08 - 12/09). The population was divided into two mutually exclusive cohorts: 1) methotrexate (MTX) monotherapy users; and 2) multiple nbDMARD users. Initiation or dose escalation of biologic and nbDMARDs in response to active disease was assessed cross-sectionally and longitudinally in comparison to the ACR recommendations. The impact of the publication of the ACR recommendations on treatment practices was compared using logistic regression stratified by disease activity adjusting for clustering of physicians and geographic region. RESULTS: After one visit, 24 to 37% of MTX monotherapy users with moderate disease activity and poor prognosis or high disease activity received care consistent with the recommendations; it was 34 to 56% after 2 visits. In the multiple nbDMARD users, 30 to 47% of those with moderate or high disease activity received care consistent with the recommendation after one visit and 43 to 51% after 2 visits. Publication of the recommendations did not significantly change treatment patterns for active disease. CONCLUSIONS: Substantial numbers of RA patients with active disease did not receive care consistent with the current ACR treatment recommendations. Innovative approaches to improve care are necessary. (c) 2011 American College of Rheumatology