Geographic, Clinical Factors of Triple Therapy Initiation in Rheumatoid Arthritis

The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

CHICAGO – The use of triple therapy with methotrexate (MTX), hydroxychloroquine, and sulfasalazine is infrequent in patients with rheumatoid arthritis (RA) in the United States and is affected by geographic and clinical factors such as coexisting psoriasis or inflammatory bowel disease (IBD) and frequency of rheumatologist visits, according to the results of a large nationwide cohort study presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24, in Chicago, Illinois.

The investigators sought to explore the geographic and clinical factors associated with triple therapy and MTX plus tumor necrosis factor inhibitor (TNFi). They used Truven MarketScan data from 2003 to 2014 from patients ≥18 years with RA and a prescription for MTX. Index date was considered the first dispensing date of the last agent prescribed to complete triple therapy or of a TNFi. Patient demographics, medications, comorbidities, and healthcare utilization linked with initiating triple therapy or a TNFi were evaluated.

A total of 46,693 patients were identified, 97.0% of whom were being treated with MTX plus TNFi and 3.0% of whom were receiving triple therapy. Women were more likely to be treated with TNFi therapy (odds ratio [OR], 1.17; 95% CI, 1.04-1.33). A significant geographic pattern was observed with respect to the initiation of TNFi therapy, with individuals from the Midwest the most likely to receive this treatment. Individuals from Nebraska reported the highest rates of triple therapy.

No link between cardiovascular diseases and either of the 2 treatments was reported. Patients with obesity, however, were more likely to initiate triple therapy. The presence of baseline psoriasis and IBD increased an individual’s likelihood of receiving TNFi (OR, 4.88; 95% CI, 3.05-7.80; and OR, 357; 95% CI, 1.14-11.14, respectively). Overall, patients being treated with TNFi therapy used more medications and had more frequent rheumatologist or inpatient visits compared with those receiving triple therapy.

The investigators concluded that although the use of triple therapy in the United States is uncommon in patients with RA, among the factors associated with its utilization were the use of bisphosphonates and proton pump inhibitors, coexisting IBD or psoriasis, and infrequent rheumatologist and inpatient visits.

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Reference

Jin Y, Kang EH, Tong A, Desai RJ, Kim SC. Factors related to initiation of TNF inhibitor versus triple therapy in rheumatoid arthritis patients. Presented at: ACR/ARHP 2018 Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 2954.

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