Indian Journal of Rheumatology (Jan 2019)
Conventional synthetic disease-modifying antirheumatic drug use by race/ethnicity and factors associated with initiating biologics in Malaysian patients with rheumatoid arthritis
Abstract
Aims: The aim of the study was to evaluate the treatment patterns of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), drug survival, and the factors in initiating biologic DMARDs based on race and ethnicity in rheumatoid arthritis (RA) patients. Materials and Methods: Data on RA patients, including race/ethnicity, who were attending University Malaya Medical Centre, Kuala Lumpur, Malaysia, and started on csDMARDs between January 2006 and December 2016, were collected retrospectively from the review of patients' medical records. Factors in initiating biologic DMARDs were identified. Results: A total of 369 RA patients received at least one csDMARD; 325 (88.1%) were female, and 271 (73.4%) were seropositive. Three main races were identified: Malay (28.7%), Chinese (33.1%), Indian (36.3%), and others (1.9%). Malay race patients were initiated on a csDMARD at a younger age (48.6 years, standard deviation [SD]: 12.4) due to younger age at onset compared to other races (P < 0.001). Overall, methotrexate was the most common csDMARD used, and 39 (11%) patients were on triple-combination therapy. Disease activity score 28–erythrocyte sedimentation rate improved at 3 months post-csDMARD treatment for all races (P < 0.001). Twenty-six (7%) patients received biologics, with a mean age at initiating first biologic of 49.8 (SD: 18.3) years. There were no significant differences in age at initiating first biologic between the race groups (P = 0.83). In fully adjusted models, race was not a factor in initiating biologics. Conclusion: CsDMARDs in RA were required at a younger age for a certain race due to younger age at onset. However, race does not predict the initiation of biologics and no significant difference in the use of combination csDMARDs between races.
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