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Retention rates of disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis
Singapore Medical Journal, 08/05/09

Agarwal S et al. – Study reports that methotrexate (MTX), used singly, had the highest retention rates among all the DMARDs used in rheumatoid arthritis (RA) patients. Disease “slip out” and adverse effects frequently required a change of the therapeutic segment.

• An evaluation of the retention rates of “therapeutic segments” of DMARDs in RA pts
• Cross-sectional study of RA pts with at least 1 year of f/u
• A therapeutic segment begins when 1 DMARD combination is instituted and it ends with a subsequent change
• Disability index for each patient was calculated using a modified health assessment questionnaire
• Retention rates were calculated using the Kaplan Meier survival analysis

• 375 DMARD courses in 102 pts were analysed
• 99 courses were being continued at the time of the study and hence were censored for the purposes of analysis
• The respective median retention period for segments containing MTX, sulfasalazine, hydroxychloroquine and leflunomide was 28, 12, 18, 15 mo
• MTX was retained longer singly than in combination
• The commonest reason for the discontinuation of DMARD segment was the disease “slipping out” of control followed by adverse effects
• Treatment termination on account of disease control was encountered in 16.3% of courses only
• As many as 63% of single DMARD segments were changed because of disease “slip out” vs 41% of combination DMARD segments
• Adverse effects were a more frequent cause of termination of the combination segments (32 vs 15%)

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