Jessica Widdifield1, Cristiano S Moura1, Yishu Wang1, Michal Abrahamowicz1, J Michael Paterson1, Anjie Huang1, Marie-Eve Beauchamp1, Gilles Boire1, Paul R Fortin1, Louis Bessette1, Claire Bombardier1, John G Hanly1, Debbie Feldman1, Sasha Bernatsky1. 1. From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
Abstract
OBJECTIVE: Disease-modifying antirheumatic drugs (DMARD) have the greatest effect when initiated early. We evaluated the influence of early exposure to DMARD on time to joint replacement surgery among patients with incident rheumatoid arthritis (RA). METHOD: Using a common protocol, we undertook 2 independent population-based cohort studies of patients with incident RA aged 66 years or older in Ontario (ON) and Quebec (QC) covering the period 2000-2013. We used Cox proportional hazards regression with time-dependent variables measuring duration of drug use in the first year, separately for methotrexate (MTX) and other DMARD, adjusting for baseline demographics, clinical factors, and other potentially confounding drug exposures. Our outcome measure was any joint replacement derived from standardized procedure codes. Adjusted HR and 95% CI were estimated. RESULTS: Among 20,918 ON and 6754 QC patients with RA followed for a median of 4.5 years, 2201 and 494 patients underwent joint replacement surgery for crude event rates of 2.0 and 1.4 per 100 person-years, respectively. Greater cumulative exposure to MTX (HR 0.97, 95% CI 0.95-0.98) and other DMARD (HR 0.98, 95% CI 0.97-0.99) in the first year after diagnosis was associated with longer times to joint replacement in ON, corresponding to a 2-3% decrease in the hazard of surgery with each additional month of early use. Similar results were observed in QC. CONCLUSION: Greater duration of exposure to DMARD soon after RA diagnosis was associated with delays to joint replacement surgery in both provinces. Early intensive treatment of RA may ultimately reduce demand for joint replacement surgery.
OBJECTIVE: Disease-modifying antirheumatic drugs (DMARD) have the greatest effect when initiated early. We evaluated the influence of early exposure to DMARD on time to joint replacement surgery among patients with incident rheumatoid arthritis (RA). METHOD: Using a common protocol, we undertook 2 independent population-based cohort studies of patients with incident RA aged 66 years or older in Ontario (ON) and Quebec (QC) covering the period 2000-2013. We used Cox proportional hazards regression with time-dependent variables measuring duration of drug use in the first year, separately for methotrexate (MTX) and other DMARD, adjusting for baseline demographics, clinical factors, and other potentially confounding drug exposures. Our outcome measure was any joint replacement derived from standardized procedure codes. Adjusted HR and 95% CI were estimated. RESULTS: Among 20,918 ON and 6754 QC patients with RA followed for a median of 4.5 years, 2201 and 494 patients underwent joint replacement surgery for crude event rates of 2.0 and 1.4 per 100 person-years, respectively. Greater cumulative exposure to MTX (HR 0.97, 95% CI 0.95-0.98) and other DMARD (HR 0.98, 95% CI 0.97-0.99) in the first year after diagnosis was associated with longer times to joint replacement in ON, corresponding to a 2-3% decrease in the hazard of surgery with each additional month of early use. Similar results were observed in QC. CONCLUSION: Greater duration of exposure to DMARD soon after RA diagnosis was associated with delays to joint replacement surgery in both provinces. Early intensive treatment of RA may ultimately reduce demand for joint replacement surgery.
Authors: Evan A Choate; Gurjit S Kaeley; Jenny Brook; Roy D Altman; John D FitzGerald; Astrid R Floegel-Shetty; David A Elashoff; Veena K Ranganath Journal: BMC Rheumatol Date: 2020-02-03