ab_S18

Use of combination therapy in the routine care of patients with rheumatoid arthritis: Physician and patient surveys

D.J. Hawley¹, F. Wolfe¹, T. Pincus²

¹National Data Bank for Rheumatic Diseases, Wichita, Kansas; and ²School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.

ABSTRACT
Aims
To describe the utilization of combination therapy in the treatment of rheumatoid arthritis (RA).

Methods
Review of published articles and abstracts, and patient/physician questionnaire data.

Results
Combination therapy was rarely used in the early 1980s and is now (1999) used for about 25% of RA patients in the US. Physician and patient surveys indicate that methotrexate plus hydroxychloroquine is the most commonly used combination in North America, and physician surveys indicate that methotrexate plus sulfasalazine is the most commonly used combination in Europe. Patient questionnaire data indicate that 13.4% of patients in the US take methotrexate and hydroxychloroquine, and between 11% and 15% of patients with recent onset of RA receive treatment with disease-modifying antirheumatic drug (DMARD) combinations.

Conclusions
Combination therapy with agents such as hydroxychloroquine and methotrexate is used in up to 25% of RA patients in the US, but the use of "aggressive combination therapy" is unusual. Whether combination therapy as currently practiced is beneficial remains to be determined.

Key words
Combination therapy, rheumatoid arthritis, methotrexate, hydroxychloroquine.

Supported in part by grants from Novartis Pharma and the Arthritis Foundation.

Please address correspondence to: Donna J. Hawley, MN, EdD, National Data Bank for Rheumatic Diseases, 1035 North Emporia, Suite 230, Wichita, Kansas 67214, USA.
E-mail: hawley@chp.twsu.edu