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Original Article
DOI: 10.1016/j.reumae.2020.08.003
Available online 7 May 2021
Clinical management and discontinuation of treatment in patients with recent onset rheumatoid arthritis in a rheumatology consultation
Manejo clínico y discontinuación de tratamiento en pacientes con artritis reumatoide de inicio en una consulta de Reumatología
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Zulema Rosales Rosadoa,
Corresponding author
zulema.rosales@salud.madrid.org

Corresponding author.
, Judit Font Urgellesb, Isabel Hernández Rodrígueza, Leticia León Mateosb, Lydia Abásolo Alcázarb, Juan Ángel Jover Jovera
a Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, Spain
b Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
Received 28 December 2019. Accepted 17 August 2020
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Figures (2)
Tables (4)
Table 1. Baseline sociodemographic and clinical characteristics.
Table 2. Description of course of treatment.
Table 3. Rates of global discontinuations, by age and ex, by cause of discontinuation.
Table 4. Rates of discontinuation according to treatment.
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Abstract
Introduction

The treatment of Rheumatoid Arthritis (RA) has changed dramatically in recent years, especially with the use of disease modifying drugs (DMARDs). Data on the management of this disease in clinical trials are abundant, but not so in real life. The aim of our study is to describe the management of an early RA cohort in daily clinical practice, especially DMARD discontinuations and reasons.

Methods

A retrospective observational study of patients with RA diagnosed between 01/07 and 12/14 followed up to 01/17, using >1 DMARD ≥ 3 months. Variables: sociodemographic, clinical, treatment, DMARD discontinuation and reason. Descriptive analysis of sociodemographic, clinical and treatment characteristics. Discontinuation incidence rate (DIR) due to survival techniques, expressed in 100 patients*year with 95% confidence interval.

Results

814 patients were included with 2388 courses of treatment, 77% women, mean age 57.5 years. First course: monotherapy (92.75%), especially Methotrexate (56.06%). In later courses there was increased combined therapy and use of biologicals (mainly Etanercept). There were 1094 discontinuations (29.5 [27.8–31.3]). The DIR was higher for adverse events (15.9 [14.7–17.3]), biologicals (49.6 [43.1–57.2]) and combined therapy. The DMAR with the lowest DIR was MTX (25.8 [23.8–28.1]).

Conclusion

Methotrexate was the most used drug, biologicals increased throughout the follow-up, the most frequent being Etanercept. The DMARD DIR was 29*100 patients per year, mainly due to adverse events. It seems to be higher in the therapies that include biologicals and combined therapies. MTX is the drug with the lowest DIR.

Keywords:
Early rheumatoid arthritis
Treatment discontinuation
Disease-modifying antirheumatic drugs
Resumen
Introducción

El tratamiento de la Artritis Reumatoide (AR) ha cambiado drásticamente en los últimos años, sobre todo con el uso de los fármacos modificadores de la enfermedad (FAME). Los datos sobre el manejo de esta enfermedad en ensayo clínico son abundantes, pero no en la vida real. El objetivo de nuestro estudio es describir el manejo de una cohorte de AR de inicio en práctica clínica diaria, especialmente las suspensiones de los FAME y sus causas.

Métodos

Estudio observacional retrospectivo de pacientes con AR diagnosticados entre 01/07 y 12/14 seguidos hasta 01/17, que usaron >1 FAME ≥ 3 meses. Variables: sociodemográficas, clínicas, tratamiento, suspensión del FAME y causa. Análisis descriptivo de las características sociodemográficas, clínicas y de tratamiento. Incidencia de suspensión (IS) por técnicas de supervivencia, expresándose en 100 pacientes*año con intervalo de confianza 95%.

Resultados

Se incluyen 814 pacientes con 2388 cursos de tratamiento, 77% mujeres, edad media 57,5 años. Primer curso: monoterapia (92,75%), especialmente Metotrexate (56,06%). En posteriores cursos aumentan terapia combinada y uso de biológico (principalmente Etanercept). Se registraron 1094 suspensiones (29,5[27,8–31,3]). La IS fue mayor para evento adverso (15,9[14,7–17,3]), biológicos (49,6[43,1–57,2]) y terapia combinada. El FAME con menor IS fue MTX (25,8[23,8–28,1]).

Conclusión

El Metotrexate fue el fármaco más utilizado, el biológico aumentó a lo largo del seguimiento, siendo el más frecuente Etanercept. La IS de los FAME fue 29*100 pacientes año, principalmente por evento adverso. Parece mayor en las terapias que incluyen biológicos y en las combinadas. El MTX es el fármaco con menor IS.

Palabras clave:
Artritis reumatoide temprana
Interrupción del tratamiento
Fármacos antirreumáticos modificadores de la enfermedad

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