Time for New Arthritis Med?

Rheumatoid arthritis therapy likely to change because of poor mental health and disability

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) Inflamed, swollen joints with firm tissue bumps under the skin can send patients to their doctors for treatment. But certain factors make patients change their medicines before long.

Rheumatoid arthritis patients were likelier to change medicines within two years of starting their first medicine if they had a disability, poor mental health or some other disease close to their joints, a new study found.

These findings show that using non-pharmacological interventions to improve patients' mental health and disability can lower the chances that their first medicine will fail, according to researchers.

"Talk to a rheumatoid arthritis specialist."

Disease modifying anti-rheumatic drug (DMARD) treatments can rapidly improve outcomes with rheumatoid arthritis when established early on, according to researchers.

The study, led by Daniel McWilliams, Postdoctoral Research Fellow in the Division of Academic Rheumatology at the Arthritis Research UK Pain Centre, looked into whether certain factors and treatment strategies for early rheumatoid arthritis are linked with changes to the first DMARD treatment.

Researchers looked at data from 766 participants with rheumatoid arthritis who were part of the Early Rheumatoid Arthritis Network (ERAN). The cohort, which began in 2002, consisted of patients from the UK who were newly diagnosed with the condition.

Participants were surveyed about their symptoms and given a health assessment at the start of the study and at a two-year follow up. Doctors reported the start of any illnesses or extra-articular diseases, which are diseases that start outside of a joint.

Methotrexate monotherapy ​(Trexall), which is considered the most effective of traditional DMARD therapies, was prescribed most often as the first round of treatment to 336 patients, or 44 percent.

Another 273 patients were prescribed sulphasalazine monotherapy (Azulfidine) as the first round of treatment, and 52 patients, or 7 percent, were prescribed a combination of the two.

Researchers found that a little more than half the patients changed their initial medication for rheumatoid arthritis within the first two years of starting that treatment.

About 56 percent of patients who changed medicines originally felt like the medications didn't work. Another 34 percent said they changed medications because of side effects.

Patients who had a disability (as defined through the health assessment questionnaire) or poor mental health were about 44 percent more likely to change medications than those without one of those conditions, researchers found.

Specifically, patients in poor mental health were likely to change medicines because of side effects.

The chance of changing medicines increased to 78 percent in patients with extra-articular disease.

At the same time, patients who were taking a combination of medicines, or triple combination therapy, were less likely to change their medications.

"Changing within two years from initial DMARD therapy was predicted by baseline disability, poorer mental health and the presence of extra-articular disease," researchers wrote in their report. "Early initiation of intensive treatment, including [Trexall] at baseline, and non-pharmacological measures to improve disability and mental health may have potential to reduce morbidity and cost from initial treatment failure." 

Looking at a subgroup of participants, researchers found that patients who took Trexall were less likely to change medications because of side effects.

Participants who were on multiple medicines were also less likely to change their medication because they felt the medicines wouldn't work. This lack of efficacy was affected by patients' disabilities, younger age, and whether they had any extra-articular diseases.

DMARDs like Azulfidine cost between $15 for the generic version and $600 for the brand medication. In comparison, injectable therapies can cost as much as $2,500.

"Successful treatment with oral DMARDs helps to delay the necessity of more aggressive and expensive injectable therapies with drugs such as Remicade, Enbrel or Humira," said Jason Poquette, BPharm, RPh, a registered pharmacist and dailyRx Contributing Expert. "For a disease affecting so many, these clues to help promote the success of DMARD therapy early in treatment are valuable and invite further study in hopes of improving patient outcomes.”

The authors noted that the way they measured inflammatory disease activity might have been affected by other factors besides the disease itself.

The DMARD medications were also changed sometimes without reason. In addition, not all the DMARD medications could be modeled without overadjusting the results.

The study, funded by Pfizer Ltd, was published online May 1 in the journal BMC Musculoskeletal Disorders.

One of the authors also received support from Pfizer, and another holds shares in the company. The other authors do not declare any other conflicts of interest.

Reviewed by: 
Review Date: 
May 5, 2013
Last Updated:
October 1, 2013