Changes in the pharmacological management of rheumatoid arthritis over two decades.

Autor:	Crossfield SSR; Leeds Institute of Rheumatic and Musculoskeletal Medicine.; Leeds Institute for Data Analytics, University of Leeds, Leeds., Buch MH; Leeds Institute of Rheumatic and Musculoskeletal Medicine.; Centre for Musculoskeletal Research, School of Biological Sciences, University of Manchester, Manchester., Baxter P; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds., Kingsbury SR; Leeds Institute of Rheumatic and Musculoskeletal Medicine.; NIHR Leeds Biomedical Research Centre., Pujades-Rodriguez M; Leeds Institute of Health Sciences, University of Leeds, Leeds, UK., Conaghan PG; Leeds Institute of Rheumatic and Musculoskeletal Medicine.; NIHR Leeds Biomedical Research Centre.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2021 Sep 01; Vol. 60 (9), pp. 4141-4151.
DOI:	10.1093/rheumatology/keaa892
Abstrakt:	Objectives: To assess whether modern management of RA has reduced the prescription of oral corticosteroids and NSAIDs and to evaluate use of pharmacological prophylaxis strategies. Methods: Using the Clinical Practice Research Datalink, we explored long-term (≥3/12 months; ≥6/12 in sub-analyses) DMARD, corticosteroid and NSAID prescribing (annually, in the year post-diagnosis and across the patient's life course to 15 years post-diagnosis), annual proportion with co-prescribing for prophylaxis of associated bone (corticosteroids, women only) and gastrointestinal (NSAIDs) comorbidity. Results: Reported incidence of RA was 5.98 (0.37) per 10 000 person-years and prevalence was 0.91% (0.014) in 2017. In 71 411 RA patients, long-term DMARD prescribing initially rose post-diagnosis from 41.6% in 1998 to 67.9% in 2009. Corticosteroid prescribing changed little, overall [22.2% in 1998, 19.1% in 2016; incident risk ratio (IRR) 0.92, 95% CI: 0.82, 1.03] and across the life course from the first to fifteenth year (22.2% to 16.9%). NSAID prescribing declined from 57.7% in 1998, and significantly so from 2008, to 27.1% in 2016 (IRR 0.50, 95% CI: 0.44, 0.56). This continued across the life course (41.2% to 28.4%). Bone prophylaxis increased to 68.1% in 2008 before declining to 56.4% in 2017; gastrointestinal prophylaxis increased from 11.5% in 1998 to 62.6% in 2017. Sub-analyses showed consistent patterns. Conclusion: Despite modern treatment strategies, corticosteroid prescribing in RA patients remains substantial and persists beyond 6 months once initiated. Rheumatologists need to determine causes and develop strategies to reduce corticosteroid use to minimize adverse event occurrence. (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.)
Databáze:	MEDLINE
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