Treatment Pathways, Time-to-initiation, and Comparative Safety and Effectiveness of Disease-Modifying Antirheumatic Drugs (DMARDs) in Rheumatoid Arthritis: Real-World Evidence from Electronic Health Records

Abstract

1.1. ABSTRACT

OBJECTIVE: This study aimed to evaluate treatment pathways after initiating Disease-Modifying Antirheumatic Drugs (DMARDs) among newly diagnosed RA patients in the US population. METHODS: A retrospective cohort analysis was conducted to evaluate current treatment pathways for newly diagnosed RA patients and compare different treatment sequences. TriNetX platform was queried for RA adults using International Classification of Disease-10 codes from 2004 to 2024. Analgesics, anti-inflammatory drugs, conventional synthetic (csDMARDs), biologic (bDMARDs), and targeted synthetic (tsDMARDs) prescribed within 3 and 12 months after RA diagnosis were analyzed. RESULTS: Of the 10 most frequently prescribed treatments at 3 and 12 months, corticosteroids were prescribed to 62% and 77% followed by csDMARDs (42%-52%), while bDMARDs were prescribed to 5% and 8% of the patients, respectively. Among csMDARDs, methotrexate was the most prescribed (36%-40%), whereas adalimumab (5%-8%) was the most prescribed bDMARDs. At 3 months, 33% of patients received DMARDs in first line of treatment (LOT); however, this increased to 41% in 6th LOT. Similarly, this increased to 44% at 12 months. 30% of patients received csDMARDs in first LOT, while only 3% received bDMARDs. However, the latter increased to 11% by the 6th LOT, while csDMARDs decreased to 33%. Adalimumab was the most common bDMARDs in 1st to 6th LOT (4%-10%), while tofacitinib was the most prescribed tsDMARDs, (1%-2%). CONCLUSION: In this real-world data analysis, only 47% of patients with RA received DMARDs therapy within the first three months following diagnosis. This contradicts the established guidelines for early DMARDs treatment for better disease outcomes.