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Utility of administrative and clinical data to predict major change in medical treatment in US Veterans enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry

1, 2, 3, 4, 5, 6

 

  1. Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT, USA. jacob.stever@hsc.utah.edu
  2. Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT, USA.
  3. Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT, USA.
  4. Amgen Inc., Thousand Oaks, CA, USA.
  5. Amgen Inc., Thousand Oaks, CA, USA.
  6. Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT, USA.

CER11378
2019 Vol.37, N°4
PI 0552, PF 0560
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PMID: 30418115 [PubMed]

Received: 04/05/2018
Accepted : 27/08/2018
In Press: 12/11/2018
Published: 27/06/2019

Abstract

OBJECTIVES:
To examine factors associated with major therapeutic changes (MTC) among US Veterans with moderate/severe rheumatoid arthritis (RA) based on Disease Activity Score based on 28 joints (DAS28).
METHODS:
We used data from patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry from 1/1/2006 through 12/31/2014. The index date was a clinic visit with DAS28 >3.2 (moderate/severe disease) following an 18-month pre-index period that included ≥2 DAS28 measurements ≥60 days apart. The patients were followed for MTC from 7 days pre-index through 90 days post-index. Poisson multivariable regression models were used to identify associations with MTC. Chart review of a subset of randomly selected patients explored factors that impacted therapeutic decisions.
RESULTS:
Among 941 patients, 396 (42.1%) had MTC. Of these, 369 (39.2%) patients had worsening DAS28 at index, 118 (12.5%) had DAS28 improvements, and 454 (48.2%) patients had no change in DAS28 versus pre-index DAS28. Of the patients with worsening DAS28, no change in DAS28, and improved DAS28, respectively, 50.5%, 62.6%, and 70.3% had no MTC. Regression analyses showed index DAS28, oral steroid or non-biologic disease-modifying anti-rheumatic drug (nbDMARD) use in the previous year were associated with an increased likelihood of MTC; use of nbDMARDs in the previous 90 days was associated with a decreased likelihood of MTC. The most common reason for not modifying therapy despite DAS28 >3.2 was a judgement of mild disease.
CONCLUSIONS:
Clinicians frequently do not institute major therapeutic changes despite DAS28 indicating moderate/severe disease activity; multiple factors are involved in real-world treatment decisions.

Rheumatology Article