Disparities in biologic DMARD use among patients with RA
medwireNews: Results of a US study suggest that type of insurance coverage and race are predictive of biologic disease-modifying antirheumatic drug (DMARD) use in patients with rheumatoid arthritis (RA).
In an analysis of claims data, the researchers found that 26,810 patients with early untreated RA who were enrolled in the commercial United Healthcare program were almost twice as likely to initiate biologic DMARD treatment over 12 months of follow-up as the 51,857 receiving public Medicaid coverage, with an odds ratio (OR) of 1.87 after adjustment for factors including demographics, comorbidities, and prior medication use.
“This suggests different accessibility to biologic DMARDs under these two types of insurance programs,” say Seoyoung Kim (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and study co-authors.
Furthermore, there were “strong race disparities” in the use of biologic DMARDs among patients in the Medicaid cohort, such that African–American participants with either early untreated or prevalent RA were 30–40% less likely to initiate or switch biologic DMARD treatment than White, non-Hispanic patients.
These associations “might be driven by differences both in accessibility to a rheumatologist and other factors, such as patients’ preferences in DMARD treatment based on benefits versus risks,” write Kim and colleagues in Arthritis Research & Therapy.
The team also found that prior use of steroids and nonbiologic DMARDs was associated with biologic DMARD initiation. However, patients with prevalent RA who were receiving methotrexate or hydroxychloroquine alongside biologic DMARD treatment were less likely to switch to another biologic treatment than those who were not receiving these nonbiologic drugs (OR=0.78 and 0.75, respectively).
These findings “may support the commonly agreed fact among rheumatologists and in clinical trials that the effects of biologic DMARDs are greater in patients with RA when combined with [methotrexate] and/or [hydroxychloroquine],” observe the researchers.
Kim and colleagues caution that the claims data “lack some clinical details such as duration or disease activity index of RA, which may have resulted in residual confounding,” and note that their findings on racial disparities “may not be generalizable to commercially insured patients” because ethnicity data were only available for patients in the Medicaid group.
Nevertheless, they conclude: “Future educational interventions aimed at addressing these disparities are warranted to ensure equitable access to biologic medications and achieve optimal disease control in RA.”
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