Polypharmacy Associated With Hospitalization, Glucocorticoid Use in Patients With RA

History of hospitalization and glucocorticoid use in patients with rheumatoid arthritis (RA) are associated with polypharmacy, according to study findings published in Clinical Rheumatology. 

Researchers conducted a single center, cross-sectional study in Japan from September to November 2020. 

A total of 991 participants with RA were included in the study. Median age of participants was 70 years; 74% were women, and the median duration of RA was 9 years.

Of the total cohort, 27% (n=270) received glucocorticoids, 67% (n=663) received methotrexate (MTX), 28% (n=277) received biologic disease-modifying antirheumatic drugs (bDMARDs), and 3.2% (n=32) received targeted synthetic DMARDs (tsDMARDs).

Researchers defined polypharmacy as 5 or more regular oral medications and excessive polypharmacy as 10 or more regular oral medications. 

The Anatomical Therapeutic Chemical (ATC) classification system was used to classify all medications into groups. Explanatory variables were derived from analyzing the participants demographics, disease activity, measured using Disease

Activity Score 28-joint count (DAS28), C-reactive protein (CRP), Health Assessment Questionnaire Disability Index (HAQ-DI) score, Charlson comorbidity index (CCI) score, along with history of hospitalizations and social factors.

Researchers observed that 601 of the 991 patients (61%) had polypharmacy, while 147 (15%) had excessive polypharmacy.

Polypharmacy was associated with increased DAS28-CRP. Excessive polypharmacy was associated with the male sex, medications with tsDMARDs, and the presence of public assistance.

The following factors were associated with both polypharmacy and excessive polypharmacy:

• Older age (odds ratio [OR], 1.03; OR, 1.03)
• Increased HAQ-DI score (OR, 1.45; OR, 2.03)
• Medications with glucocorticoids (OR, 5.57; OR, 2.42)
• History of hospitalization (OR, 1.92; OR, 1.87)
• Visits to other internal medicine centers (OR, 2.93; OR, 2.03
• Increased CCI score (OR, 1.28; OR, 1.36)

Study limitations included the lack of generalizability of data due to its single-center design, which could have affected the external validity of the study as medication practices may vary in regions with different health care systems.

Study authors concluded, “Although hospitalization is an important opportunity for medication review in patients with polypharmacy, it may be insufficiently effective. Therefore, efforts should be made to review medications during hospitalization and continue prescribing only after examining whether continuation is necessary.”