TY - JOUR
T1 - Association of patient- and hospital-level predictors with patterns of initial treatment in patients with rheumatoid arthritis
T2 - findings from a national cohort study
AU - Yang, Zijing
AU - Alveyn, Edward
AU - Russell, Mark
AU - Bechman, Katie
AU - Coalwood, Callum
AU - Price, Elizabeth
AU - Abhishek, Abhishek
AU - Norton, Sam
AU - Galloway, James
N1 - Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.
PY - 2025/6/1
Y1 - 2025/6/1
N2 - Objectives: To update the first-line conventional synthetic DMARDs (csDMARDs) prescribing pattern, describe change and variation across demographical and geographical factors in the RA population, and identify individual and hospital factors associated with it. Methods: This retrospective cohort study included newly diagnosed RA adult patients from 1 May 2018 to 1 April 2023 in the UK. We used adjusted multinomial logistic regression with random effect to explore associations with different first-line csDMRAD prescription and to account for hospital-level clustering. Result: We identified 15 462 RA patients who received csDMARD treatment. Overall, 57% received MTX monotherapy and 14% received MTX combination therapy as first-line treatment. MTX is the most frequently medication, following by HCQ and SSZ. Compared with non-MTX prescription, prescription of MTX monotherapy [adjusted odds ratio (aOR) 1.25 95% CI (1.22–1.29)] and MTX combination therapy [aOR 1.45 (1.38–1.52)] was significantly higher in patients with higher DAS28, but lower in the non-White individuals with comorbidities: lung disease, cancer, fracture and heart attack. Among those who received MTX, monotherapy is more likely be prescribed in patients with higher DAS28 [aOR 1.08 (1.05–1.11)] and without lung disease [aOR 0.5 (0.44–0.56)], compared with combination therapy. Around 20% of the variability in first-line csDMARD prescribing was attributed to the hospital level. Conclusion: In this cohort study of new-onset RA population, both individual- and institution-level variation in first-line csDMARD treatment strategy was evident. Gender, ethnicity, disease activity, and comorbidities, especially lung disease, were associated with disparities at the individual level.
AB - Objectives: To update the first-line conventional synthetic DMARDs (csDMARDs) prescribing pattern, describe change and variation across demographical and geographical factors in the RA population, and identify individual and hospital factors associated with it. Methods: This retrospective cohort study included newly diagnosed RA adult patients from 1 May 2018 to 1 April 2023 in the UK. We used adjusted multinomial logistic regression with random effect to explore associations with different first-line csDMRAD prescription and to account for hospital-level clustering. Result: We identified 15 462 RA patients who received csDMARD treatment. Overall, 57% received MTX monotherapy and 14% received MTX combination therapy as first-line treatment. MTX is the most frequently medication, following by HCQ and SSZ. Compared with non-MTX prescription, prescription of MTX monotherapy [adjusted odds ratio (aOR) 1.25 95% CI (1.22–1.29)] and MTX combination therapy [aOR 1.45 (1.38–1.52)] was significantly higher in patients with higher DAS28, but lower in the non-White individuals with comorbidities: lung disease, cancer, fracture and heart attack. Among those who received MTX, monotherapy is more likely be prescribed in patients with higher DAS28 [aOR 1.08 (1.05–1.11)] and without lung disease [aOR 0.5 (0.44–0.56)], compared with combination therapy. Around 20% of the variability in first-line csDMARD prescribing was attributed to the hospital level. Conclusion: In this cohort study of new-onset RA population, both individual- and institution-level variation in first-line csDMARD treatment strategy was evident. Gender, ethnicity, disease activity, and comorbidities, especially lung disease, were associated with disparities at the individual level.
KW - conventional synthetic disease-modifying antirheumatic drugs
KW - methotrexate
KW - rheumatoid arthritis
KW - treatment strategy
UR - http://www.scopus.com/inward/record.url?scp=105006715724&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/keae717
DO - 10.1093/rheumatology/keae717
M3 - Article
C2 - 39718801
AN - SCOPUS:105006715724
SN - 1462-0324
VL - 64
SP - 3379
EP - 3387
JO - Rheumatology
JF - Rheumatology
IS - 6
ER -
