Presentation: Contemporary Trends in Rheumatoid Arthritis Disease Activity Reduction and Medication Use (2007)

341 Contemporary Trends in Rheumatoid Arthritis Disease Activity Reduction and Medication Use

Purpose: Recent literature suggests that the course of RA has become milder over time, possibly due to more aggressive treatment strategies. We studied the trends and medication correlates of disease activity in an observational cohort of RA patients.
Methods: The Brigham RA Sequential Study (BRASS) is a longitudinal cohort of RA patients followed in a hospital-based practice of 21 rheumatologists. The cohort began enrolling in 2003 and baseline data include demographics, joint examination, RF and CCP titers, and medications. DAS28-CRP scores are measured annually, and medication changes are recorded every 6 months. We analyzed trends in medication use over 24 months using McNemar’s test, and examined trends in DAS28-CRP over the same period using a mixed model.
Results: There are 961 subjects enrolled in BRASS (82% female, mean age of 57 years, mean disease duration of 14 years, and mean DAS28-CRP 4.1). Among 591 subjects with medication data at baseline and 24 months, there were significant declines in the use of steroids (p=0.003) and NSAIDs (p<0.001) and a significant increase in the use of TNF inhibitors (p<0.001). For example, while 51% of subjects were on NSAIDs at baseline, only 44% were on NSAIDs at 24 months. 39% of subjects were on TNF inhibitors at baseline, compared to 46% at 24 months.
In 686 subjects with laboratory data at 12 months, the mean DAS28-CRP was 3.5. In 394 subjects with data at 24 months, the mean DAS28-CRP remained stable at 3.5. After adjusting for age, sex, disease duration, and CCP, the trend toward improvement in DAS28-CRP is still observed between baseline and 24 months (p<0.001).
In our subset of subjects with available DAS28-CRP and medication use data at 12 months, 74 subjects who started TNF inhibitors demonstrated a mean reduction in DAS28-CRP of 1.12 over the first 12 months (p<0.001). Improvement in DAS28-CRP was also noted in subjects who were never on TNF inhibitors (n=378, mean reduction 0.53, p<0.001), as well as those who were on TNF inhibitors both at baseline and 12 months (n=247, mean reduction 0.50, p<0.001). The improvement noted in subjects who started TNF inhibitors was significantly greater than that noted in subjects who were never on TNF inhibitors (p<0.001). Subjects who stopped TNF inhibitors between baseline and 12 months had a non-significant increase in DAS28-CRP of 0.12 (n=28, p=0.59).
Conclusion: In this large practice-based clinical cohort, there was a significant trend toward a decrease in disease activity over the initial 24 months of follow-up. During this same time period, the use of TNF inhibitors increased and NSAID and steroid use decreased. While it is difficult to correlate these observations in a non-trial setting, the trends are compelling, and are consistent with findings in large clinical trials of biologic therapies.

 K.L. Batra, None; J. Cui, Millennium Pharmaceuticals, 2; Biogen IDEC MA Inc., 2; R. Glass, Millennium Pharmaceuticals, 2; Bristol Myers Squibb Foundation, 2; Biogen IDEC MA Inc., 2; D.H. Solomon, Merck, 2; Pfizer, 2; Savient, 2; Proctor & Gamble, 2; Millennium Pharmaceuticals, 2; N.E. Maher, Millennium Pharmaceuticals, 2; Bristol Myers Squibb, 2; Biogen IDEC MA Inc., 2; M.E. Weinblatt, Millennium Pharmaceuticals, 2; Biogen, 2; Amgen, 2; Abbott, 2; Millennium Pharmaceuticals, 5; Biogen, 5; Amgen, 5; Abbott, 5; Wyeth, 5; Centocor, 5; UCB, 5; N.A. Shadick, Millennium Pharmaceuticals, 2; Biogen IDEC MA Inc., 2; Glaxo Smith Kline, 2; Dow Chemical Corporation, 2; Bristol Myers Squibb Foundation, 2.