Treatment of rheumatoid arthritis in the USA: premature use of tumor necrosis factor inhibition and underutilization of concomitant methotrexate

Abstract

James R O’Dell,1 Stanley B Cohen,2 J Carter Thorne,3 Joel Kremer4 1Department of Rheumatology, Division of Rheumatology and Immunology, University of Nebraska Medical Center and the Omaha VA, Omaha, NE, USA; 2Department of Internal Medicine, Metroplex Clinical Research Center, University of Texas Southwestern Medical School, Dallas, TX, USA; 3Division of Rheumatology, University of Toronto, Southlake Regional Health Centre, Toronto, ON, Canada; 4The Center for Rheumatology, Albany Medical College, Albany, NY, USA Purpose: The objective of this study was to assess the treatment for patients with rheumatoid arthritis (RA) in the USA. Patients and methods: This study entailed analysis of claims data for patients with RA who initiated treatment with oral methotrexate (MTX) or a biologic in 2009 (n=48,910) or 2012 (n=107,636) and had follow-up for 4 years (2009 cohort) or 2 years (2012 cohort). Results: A biologic was initiated before MTX for 27% of the 2009 cohort and 36% of the 2012 cohort. Concomitant use of MTX and a biologic declined from 74.1% (2009 cohort) to 45.4% (2012 cohort). Conclusion: MTX is underused in the treatment of RA in the USA. Keywords: biologic, claims, methotrexate, tumor necrosis factor

Keywords

• biologic
• claims
• methotrexate
• tumor necrosis factor