Document Detail

Changing patterns of medication use in patients with rheumatoid arthritis in a Medicaid population.
MedLine Citation:
PMID:  18499716     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To examine changes in patterns of medication utilization in patients with RA. METHODS: Data from Tennessee Medicaid (TennCare) databases (1995-2004) were used to identify adults with both a diagnosis of RA and at least one DMARD prescription each year. Annual age-specific utilization of DMARDs, glucocorticoids, NSAIDs and narcotics was measured on the last day of each year to determine the point prevalence of use of these agents. RESULTS: Records from 23 342 patients with treated RA were analysed. Most patients were females (78%) and white (74%). The median age was 57 yrs (interquartile range: 48-65). The proportion of patients who had a current DMARD prescription on the index date increased from 62% in 1995 to 71% in 2004 (P < 0.001). MTX was the most commonly used DMARD. By the end of 2004, 22% of patients had a current prescription for a biologic, and etanercept represented 51% of all biologic therapies. During the study period, the overall utilization of glucocorticoids decreased from 46% to 38% (P < 0.001), whereas NSAID utilization increased from 33% to 38% (P < 0.001), and use of narcotics increased from 38% to 55% (P < 0.001). A secondary analysis that identified RA patients based on diagnosis codes alone, showed similar patterns, but lower DMARD utilization which increased from 33% to 52% overall and from 0% to 16% for biologics. CONCLUSIONS: The utilization of DMARDs increased in TennCare patients with RA, and by 2004, use of biologics was substantial. Although glucocorticoid utilization decreased, use of both NSAIDs and narcotics increased.
C G Grijalva; C P Chung; C M Stein; E F Mitchel; M R Griffin
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.     Date:  2008-05-22
Journal Detail:
Title:  Rheumatology (Oxford, England)     Volume:  47     ISSN:  1462-0332     ISO Abbreviation:  Rheumatology (Oxford)     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-18     Completed Date:  2008-07-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883501     Medline TA:  Rheumatology (Oxford)     Country:  England    
Other Details:
Languages:  eng     Pagination:  1061-4     Citation Subset:  AIM; IM    
Department of Preventive Medicine, Vanderbilt University School of Medicine, 1500 21st Avenue, 2600 VAV, Nashville, TN 37212, USA.
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MeSH Terms
Analgesics, Opioid / therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Antirheumatic Agents / therapeutic use*
Arthritis, Rheumatoid / drug therapy*,  epidemiology
Drug Therapy, Combination
Drug Utilization / statistics & numerical data,  trends
Glucocorticoids / therapeutic use
Immunologic Factors / therapeutic use
Medicaid / statistics & numerical data,  trends*
Middle Aged
Tennessee / epidemiology
United States / epidemiology
Grant Support
290200500421//PHS HHS
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anti-Inflammatory Agents, Non-Steroidal; 0/Antirheumatic Agents; 0/Glucocorticoids; 0/Immunologic Factors

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