Acknowledgements

We appreciated the Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital for statistics work. We also appreciated the Kawasaki Center and Mitochondria center, Kaohsiung Chang Gung Memorial Hospital for assistance.
Authors’ contributions Zon-Min Lee: Drafting the article and revising it critically for important intellectual content Yao Hsu Yang: acquisition of data, analysis and interpretation of data Ho-Chang Kuo: analysis and interpretation of data Ya-Han Shen: acquisition of data and analysis Hong-Ren Yu: Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved Yu-Jih Su: Substantial contributions to conception, design, discussion, and final approval of the version to be published
Declarations This study has been approved by Institutional Review Board (IRB) of Chang Gung Memorial Hospital: 201801196B0C501 Competing interests All authors hereby declare that they have no financial interests to disclose in relation to this article.
Funding This study was funded by the following grants: CFRPG8H0231 from Chang Gung Memorial Hospital in Taiwan.

Abstract

Aim: 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.
Method: 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.
Results: 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.
Conclusion: 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% compared to the steroids and NSAIDs doses before biologics treatment.
Keywords: rheumatoid arthritis, biological agent, cohort study, cumulative days, steroid, painkillers, NSAID
Key points:
  1. Treatment with biologics within 2.24 years of rheumatoid arthritis lessen the days of prescription of glucocorticoids and painkillers in 12 months. (Table 2)
  2. Take whole rheumatoid arthritis disease duration into consideration, using biologics treatment in the early quartile, i.e. using biologics longer than 75% of disease duration, significantly reduced the prescription days of steroid. (Table 3)
  3. Gender and the age by the time of using biologics are two independent factors associated with decreasing at least half of the prescription days of glucocorticoids and other traditional treatments. (Table 4)
  4. The reimbursement of biologics other than the Etanercept and the Adalimumab as first-line biologics treatment was not available in Rituximab and Tocilizumab by 2013, and the Golimumab was not available until the end of 2012, which could limit the case numbers in this research. (Limitation)