Rheumatoid arthritis is the most common chronic autoimmune disease that affects the joints. RA has the potential for joint damage and deformity, with loss of function. The cause of RA is unknown. It affects people of all ages, and women more commonly than men. RA causes pain, stiffness and swelling, generally in multiple joints. RA may affect any joint, but the small joints in the hands and feet are most frequently involved. Rheumatoid inflammation may also develop in other organs such as the lungs.
Anti-tumor necrosis factor (commonly called anti-TNF) drugs are a class of drugs that are used worldwide to treat inflammatory conditions such as RA, psoriatic arthritis, juvenile arthritis, inflammatory bowel disease (Crohn’s and ulcerative colitis), ankylosing spondylitis and psoriasis. These drugs are able to reduce inflammation and stop disease progression.
“Little is known about the impact of switching patients from anti-TNFs for reasons other than efficacy and safety, such as cost containment,” explains principal investigator in the study, Douglas C. Wolf, MD; Atlanta Gastroenterology Associates., “so, we conducted this study to fill this research gap.” Dr. Wolf’s team of researchers identified 166 patients with RA — through a medical chart review — whose physicians had reported them as being stable on anti-TNFs for six or more months. These patients were placed into 83 pairs, with each pair having one patient who switched or discontinued their use of anti-TNF due to non-medical reasons and one patient who remained on the treatment. Once the first patient switched or discontinued use of the treatment, the researchers retrospectively followed the pair for 12 months. Both patients in each pair were being seen by the same rheumatologist.
When looking at characteristics of the groups at the start of the study, the researchers noted that those who switched or discontinued were more likely to be Hispanic (28 percent); otherwise, there were no significantly different sociodemographic characteristics, disease characteristics, co-existing diseases, medication use (anti-TNF and other therapies used to treat RA), or medical services (such as hospitalizations, emergency department visits and office visits).
With the majority of things equal among the two groups, the researchers were able to focus on what the impact of switching or discontinuing anti-TNFs would have on patients. They looked at disease flares, disease control and use of medical services.
Throughout the 12-month follow-up period, it was observed that only 48 percent of those who switched or discontinued anti-TNF had well-controlled disease symptoms reported by the rheumatologist. This number was significantly lower than their partners who stayed on the therapy; 84 percent of this group was reported to have well-controlled symptoms. Additionally, the patients who switched or discontinued had a greater risk of flares, more frequent flares across all disease severity levels, and were at great risk for emergency department visits (even making those visits more frequently). “These real-world results suggest that switching well-controlled patients from their therapy for a cost-related reason may have a negative impact on their outcomes,” says Dr. Wolf of the findings. “We saw that non-medical switching or discontinuation was associated with significantly worse clinical outcomes and increased use of medical services; to that end, physicians may want to consider the potential negative effects of non-medical discontinuation or switching in clinical practice.”
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About the American College of RheumatologyHeadquartered in Atlanta, Ga., the American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to Advance Rheumatology! In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.
About the ACR/ARHP Annual MeetingThe ACR/ARHP Annual Meeting is the premier meeting in rheumatology. For more information about the meeting, visit http://www.acrannualmeeting.org/ or join the conversation on Twitter by using the official #ACR15 hashtag.
ACR Abstract 555http://acrabstracts.org/
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