Biological disease-modifying antirheumatic drug (bDMARD) use and disease activity for patients with rheumatoid arthritis (RA) vary globally, and the complex relationship between countries’ bDMARD use and disease activity is influenced by socioeconomic status, prescription and reimbursement rules, and affordability, according to a study published in the Annals of the Rheumatic Diseases.
To assess the associations between countries’ socioeconomic status, clinical outcomes, and bDMARD usage, as well as the effect of cost, access, and rules of prescription and reimbursement of bDMARDs, the study investigated daily practice data from the METEOR registry database for 20,379 patients with RA in 12 different countries with a range of socioeconomic conditions.
The analysis revealed that patients living in countries that have a higher gross domestic product (GDP) per capita and greater bDMARD usage exhibit lower disease activity scores of 28 joints (DAS28) and more frequent DAS28remissions (DAS28 lower by β= −0.32; 95% CI, −0.41 to −0.021), with an additional 4.2% of patients in remission for every 10,000 additional international dollars of GDP. Lowered rates of bDMARD use were associated with lower socioeconomic status, stricter rules for prescription and reimbursement, and lower affordability of bDMARDs, but were not associated with reduced functional ability, with −0.024 (95% CI, −0.091 to 0.042) lower Health Assessment Questionnaire scores for every 10% increase in bDMARD use.
Study investigators conclude that “while we suggest an inverse relationship between the countries’ bDMARD-usage and mean DAS28, this relationship is influenced by many other factors, including countries’ GDP per capita, strictness of prescription and reimbursement rules and affordability of bDMARDs. Altogether these findings point to the existence of worldwide inequity with regard to optimal (access to) RA healthcare.”
Bergstra SA, Branco JC, Vega-Morales D, et al. Inequity in access to bDMARD care and how it influences disease outcomes across countries worldwide: results from the METEOR-registry [published July 6, 2018]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2018-213289