Clinical Management and Discontinuation of Treatment in Patients with Recent Onset Rheumatoid Arthritis in a Rheumatology Consultation

Introduction: The treatment of rheumatoid arthritis has changed dramatically in recent years, especially with the use of disease modifying drugs (DMARDs). Data on the management of this disease in clinical trials are abundant, but not so in real life. The aim of our study is to describe the management of an early rheumatoid arthritis cohort in daily clinical practice, especially DMARD discontinuations and reasons.

Methods: A retrospective observational study of patients with rheumatoid arthritis diagnosed between 01/07 and 12/14 followed up to 01/17, using>1 DMARD≥3 months.

Variables: sociodemographic, clinical, treatment, DMARD discontinuation and reason. Descriptive analysis of sociodemographic, clinical and treatment characteristics. Discontinuation incidence rate (DIR) due to survival techniques, expressed in 100 patients/year with 95% confidence interval.

Results: 814 patients were included with 2,388 courses of treatment, 77% women, mean age 57.5 years. First course: monotherapy (92.75%), especially methotrexate (56.06%). In later courses there was increased combined therapy and use of biologicals (mainly etanercept). There were 1,094 discontinuations (29.5 [27.8-31.3]). The DIR was higher for adverse events (15.9 [14.7-17.3]), biologicals (49.6 [43.1-57.2]) and combined therapy. The DMAR with the lowest DIR was methotrexate (25.8 [23.8-28.1]).

Conclusion: Methotrexate was the most used drug, biologicals increased throughout the follow-up, the most frequent being Etanercept. The DMARD DIR was 29/100 patients per year, mainly due to adverse events. It seems to be higher in the therapies that include biologicals and combined therapies. Methotrexate is the drug with the lowest DIR.

Keywords: Artritis reumatoide temprana; Disease-modifying antirheumatic drugs; Early rheumatoid arthritis; Fármacos antirreumáticos modificadores de la enfermedad; Interrupción del tratamiento; Treatment discontinuation.