STATESBORO, GA—What factors can cause delays in initiation of initial disease-modifying antirheumatic drug, or DMARD, in patients newly diagnosed with rheumatoid arthritis (RA)?

A retrospective cohort descriptive study used administrative data from the TRICARE program from 2007 to 2012 to help answer that question. Results were published in Seminars in Arthritis & Rheumatism.1

Georgia Southern University-led researchers identified incident RA cases using billing codes and initial DMARD receipt using prescription fill date. The study team, which also included members from the Uniformed Services University of the Health Sciences, quantified the time between RA presentation and initial DMARD receipt, analyzed changes in delay over the study period and investigated predictors of treatment delay of more than 90 days) using logistic regression.

Results indicated that the mean time from initial RA presentation to first DMARD prescription receipt was 125.3 days (SD 175.4) among 16,680 patients, mean age 47.2, with incident RA for which DMARDs were prescribed.

More than one-third, 35.6%, of the patients initiated DMARD more than 90 days after diagnosis, although treatment delay declined over the study period—mean days to DMARD was 144.7 days in 2007 but dropped to 109.7 days by 2012.

Researchers reported that patients prescribed opioids had mean time to DMARD of 212.8 days (SD 207.4) compared to mean of 77.3 days (SD 132.3) for those who did not use the painkillers. Furthermore, they noted, patients prescribed opioids between RA presentation and initial DMARD receipt were more likely to have delay in initial DMARD (OR 4.07, 95% CI: 3.78–4.37).

“In this large U.S. nationwide study, delays in initial DMARD receipt for incident RA were common but time to treatment improved in recent years, study authors concluded. “While further analysis using clinical data is warranted, these findings suggest that limiting opioid use in patients newly presenting with RA may decrease delay in initiating DMARDs.”

1. Kimsey L, Weissman JS, Patel A, Drew A, Koehlmoos T, Sparks JA. Delay in initiation of DMARD or anti-inflammatory therapy in patients newly diagnosed with rheumatoid arthritis: An analysis of United States Military Health System TRICARE beneficiaries. Seminars in Arthritis & Rheumatism. Available online 18 July 2018