For older patients with rheumatoid arthritis (RA), there is considerable variation in time to receipt of first biologic disease-modifying antirheumatic drug (DMARD) after prescription of the first conventional synthetic (cs) DMARD, according to a study published online Dec. 6 in JAMA Network Open.
Mark Tatangelo, from the University of Toronto, and colleagues describe trends in access to the first biologic DMARD prescription in 17,672 patients with an incident RA diagnosis at age 67 years or older between 2002 and 2015, who received at least one csDMARD and had identical comprehensive health insurance coverage in Ontario, Canada.
The researchers found that older age (hazard ratio for every five-year increase, 0.66), male sex (hazard ratio, 0.76), and distance to the nearest rheumatologist (hazard ratio per 10-km increase, 0.99) were associated with longer time to receipt of a biologic prescription. Rheumatologists and primary care physicians were the main prescribers (70.6 and 12.1 percent, respectively). Rheumatologists' preferences for using biologic DMARDs increased over time, from 1.7 percent in 2001 to 4.9 percent in 2015, after adjustment for the number of eligible patients. Substantial variation was seen between prescribers in the rates of prescribing a first biologic DMARD (65 percent variance) after adjustment for calendar year and patient-, prescriber-, and regional-level characteristics.
"These differences in prescriber preferences have unclear implications for patient outcomes but show that between-prescriber differences exist in health care delivery for patients with RA, despite identical health insurance coverage," the authors write.
Two authors disclosed financial ties to the pharmaceutical industry.