Top Rheumatoid Arthritis Drug Underutilized

Research finds patients are not staying on methotrexate long enough before switching to more costly biologic drugs.

A leading treatment for rheumatoid arthritis (RA) is underutilized by physicians, which ultimately leads patients to costlier therapies, a recent study suggests.

James O'Dell, MD, chief of the University of Nebraska Medical Center divisions of rheumatology and immunology said patients are not staying on the disease modifying anti-rheumatic (DMARD) drug methotrexate long enough prior to switching to more expensive biologic drugs.

"There are some major concerns here," Dr. O'Dell said. "It shows that we're not doing all we should with methotrexate, our number one therapy for rheumatoid arthritis."

DMARDs, while less expensive, are able to produce similar clinical benefits as biologic drugs in most patients with RA, according to the study authors.

Researchers evaluated anonymous claims data produced by Symphony Health Solutions for 274 million patients to track the treatment of 35,640 RA patients between 2009 and 2014.

Researchers found 15,599 (43.8%) maintained treatment with oral methotrexate; 17,528 (49.2%) added or switched to biologic therapy, which was added at a median of 170 days; 41.5% of patients added a biologic agent within 90 days of starting oral methotrexate; and approximately 7% of patients switched from oral to subcutaneous methotrexate.

Researchers noted that when oral methotrexate is not producing the desired results, patients should switch to subcutaneous methotrexate at a higher dose.

"What we found in patients who made a treatment change was that 87% added a biologic instead of trying subcutaneous methotrexate," Dr. O'Dell said. "Patients switched to biologics too quickly — 41% switched in 3 months or less."

Furthermore, the study found 72% of patients switching from oral to subcutaneous methotrexate stayed on the treatment for 5 years, while the remaining 28% eventually switched to a biologic at a median of 289 days on subcutaneous methotrexate.

"The bottom line is that more appropriate optimization of methotrexate could lead to better control of RA and produce significant cost savings,” Dr. O'Dell said. “Oral methotrexate is underdosed in clinical practice, and subcutaneous methotrexate is underutilized."