Use of Disease-modifying Antirheumatic Drugs, Biologics, and Corticosteroids in Older Patients With Rheumatoid Arthritis Over 20 Years

Objective. To examine changes in prescribing patterns, especially the use of corticosteroids (CS), in patients with rheumatoid arthritis (RA) over 2 decades. Methods. This was a secondary analysis of health administrative data using a previously validated dataset and case definition for RA. Cases were matched 1:4 by age and sex to controls within a population of approximately 1 million inhabitants with access to universal health care. Longitudinal data for incident and prevalent RA cases were studied between 1997 and 2017. Results. There were 8240 RA cases (all >= 65 yrs) with a mean (SD) age 72.2 (7.5) years and 70.6% were female. Over 20 years, annual utilization of coxibs in prevalent RA cases fell with a concomitant increase in disease-modifying antirheumatic drugs (DMARDs) and biologics. Over the same period, CS use was largely unchanged. Approximately one-third of patients had at least 1 annual prescription for CS, most frequently prednisone. The mean annual dose showed a modest reduction and the duration of utilization in each year shortened. Rheumatologists prescribed CS less frequently and in lower doses than other physician groups. For incident RA cases, there was a significant fall in annual prescribed dose of prednisone by rheumatologists over time. Conclusion. In older adults with RA, the utilization of DMARDs and biologics has increased over the past 20 years. However, the use of CS has persisted. Renewed efforts are required to minimize their use in the long-term pharmacological management of RA.

Automated summary

Over the past 20 years, the use of disease-modifying antirheumatic drugs (DMARDs) and biologics has increased in older adults with rheumatoid arthritis (RA), while the use of corticosteroids (CS) has remained consistent. Further efforts are needed to minimize the use of CS in the long-term pharmacological management of RA.