Comparison of glucocorticoids and painkiller prescribed days between
rheumatoid arthritis patients receiving early and late treatment with a
biological agent via a population-based cohort study.
Abstract
Comparison between early biologics treatment and late biologics
treatment of rheumatoid arthritis (RA) patients in decreasing
prescription days of glucocorticoids and painkillers by using the Taiwan
National Health Insurance Research database from January 1, 1997 to
December 31, 2013. We defined early use of biologics as biologics
prescribed within 2.24 years after the RA diagnosis, and the late use of
biologics was defined as those prescribed after 2.24 years of the RA
diagnosis. These definitions are based on previous studies defining
early arthritis as arthritis within 2 years of diagnosis, while we
needed another 3 months for application biologics here in Taiwan, which
equals a total of 2.24 years. Among the 821 patients, 410 patients
(50%) were classified in the Early group, and the other 411 patients
(50%) were classified in the Late group. The use of any of these three
types of medication, including steroids, disease modifying antirhuematic
drugs, and nonsteroid anti-inflammatory drug (NSAID) was changed
significantly after biologics treatment. Comparing between before and
after biologics treatment, oral medication was significantly tapered
(all p <0.0001). The results show that men are 1.81 times more
likely than women to taper oral glucocorticoids and NSAIDs. Younger age
(<45) patients are 1.91 times more likely to taper steroids
and NSAIDs than those aged over 65 years old. Both gender and age were
found to be independent factors that could decrease days of prescription
of both steroids and NSAIDs in early use of biologics agents. This study
indicates that younger patients only need short-term (2.53±1.92 years,
p=0.03) and early treatment with biologics (within 2.24 years of
diagnosis of RA), just in order to taper steroids and NSAIDs to less
than 50% than before biologics treatment.