Document Detail


Disappointing longterm results with disease modifying antirheumatic drugs. A practice based study.
MedLine Citation:
PMID:  10555887     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the longterm effectiveness of disease modifying antirheumatic drugs (DMARD) in an inception cohort of patients with rheumatoid arthritis (RA) seen by rheumatologists. METHODS: We performed a retrospective audit of the records of patients with onset of RA between January 1985 and June 1994. Charts were reviewed from the time of diagnosis to the last consult. Survival analysis was performed using Kaplan-Meier and Cox proportional hazard regression to adjust for potential confounders. RESULTS: A total of 2296 DMARD therapies were analyzed. Roughly half were started within 2 years of disease onset. By 16 months, 50% of the DMARD therapy courses had been discontinued, and after 4.5 years 75% had been discontinued. Over all, methotrexate (MTX) had the highest probability of continuation. After roughly 3 years 50% of patients were still receiving MTX, compared to one-third of patients who received antimalarials or intramuscular gold, 30% D-penicillamine, 25% sulfasalazine, and 18% oral gold. After 6 years, when considering all DMARD together, only 20% of the therapies had not been discontinued, with no substantial differences between drugs. Toxicity from gold compounds occurred within the first 18 months of therapy and stabilized thereafter. For MTX, withdrawals due to toxicity continued throughout therapy. CONCLUSION: This is the largest observational study examining the longterm termination rates of DMARD in patients followed from the time of their initial consult. Our results confirm previous reports of short therapeutic times, even for patients treated early in the course of their disease. MTX appears to be the best drug within the first 5 years of disease. These differences, however, decrease in the longer term. It is unclear whether the results observed for MTX within the first years of therapy translate to better health status in the longer term when compared to other DMARD.
Authors:
G Galindo-Rodriguez; J A Aviña-Zubieta; A S Russell; M E Suarez-Almazor
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of rheumatology     Volume:  26     ISSN:  0315-162X     ISO Abbreviation:  J. Rheumatol.     Publication Date:  1999 Nov 
Date Detail:
Created Date:  1999-12-17     Completed Date:  1999-12-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  2337-43     Citation Subset:  IM    
Affiliation:
Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
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MeSH Terms
Descriptor/Qualifier:
Antirheumatic Agents / adverse effects,  therapeutic use*
Arthritis, Rheumatoid / drug therapy*,  mortality
Cohort Studies
Female
Humans
Male
Methotrexate / adverse effects,  therapeutic use*
Middle Aged
Multivariate Analysis
Retrospective Studies
Survival Analysis
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antirheumatic Agents; 59-05-2/Methotrexate
Comments/Corrections
Comment In:
J Rheumatol. 1999 Nov;26(11):2291-3   [PMID:  10555878 ]
J Rheumatol. 2000 Aug;27(8):2052-3   [PMID:  10955358 ]
J Rheumatol. 2001 Jan;28(1):215   [PMID:  11196530 ]

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