The changing use of disease-modifying anti-rheumatic drugs in individuals with rheumatoid arthritis from the United Kingdom General Practice Research Database
The changing use of disease-modifying anti-rheumatic drugs in individuals with rheumatoid arthritis from the United Kingdom General Practice Research Database
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DOI：
10.1093/rheumatology/kei024
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发表时间：
2005-11-01
期刊：
影响因子：
5.5
通讯作者：
Cooper, C
中科院分区：
文献类型：
--
作者：
Edwards, CJ;Arden, NK;Cooper, C
目标.描述疾病缓解抗风湿药物（DMARDs）在类风湿关节炎（RA）治疗中的应用及其变化趋势。我们使用全科医学研究数据库（GPRD）来描述使用ICD-9编码识别的RA患者使用DMARD的情况。GPRD是一个英国国家数据库，包含来自683个全科诊所的700多万人的记录。研究对象是1987年至2002年之间。调查个体DMARD使用率、持续时间及变化趋势。确定了34，364例RA患者。在研究期间，只有17115（50%）人至少服用了一种DMARD。在研究期间，最常处方的DMARD是柳氮磺胺吡啶（46.3%），然后是甲氨蝶呤（31.4%）。甲氨蝶呤的使用增加了17倍（从1988年占所有DMARD处方的1.8%增加到2002年的30%），而金的使用下降了（从13.2%下降到2.3%）。使用Kaplan-Meier生存曲线分析DMARD持续性显示，甲氨蝶呤使用持续时间显著长于其他DMARD，估计中位数为8.1年。泼尼松龙在任何一年中用于高达50%的RA患者，并且在整个研究期间保持相当稳定。从大型初级保健数据库中确定的大量临床诊断为RA的个体未接受DMARD。这项工作表明，许多RA患者没有得到适当的治疗，这可能对关节损伤和一般健康产生重大的长期后果。
Objectives. To describe the use of disease-modifying anti-rheumatic drugs (DMARDs) in the treatment of rheumatoid arthritis (RA) and changing trends in their use.Methods. We used the General Practice Research Database (GPRD) to describe DMARD use by patients with RA identified using ICD-9 codes. The GPRD is a UK national database containing records of more than 7 million individuals from 683 general practices. Subjects were studied between 1987 and 2002. The prevalence and duration of individual DMARD use and changing trends in DMARD use were investigated.Results. Thirty-four thousand three hundred and sixty-four patients with RA were identified. Only 17 115 (50%) individuals were prescribed at least one DMARD during the study period. The most commonly prescribed DMARD over the study period was sulphasalazine (46.3%) and then methotrexate (31.4%). Use of methotrexate has increased 17-fold (1.8% of all DMARD prescriptions in 1988 to 30% in 2002) whereas use of gold has fallen (13.2% to 2.3%). Analysis of DMARD persistence using Kaplan-Meier survival curves showed the methotrexate use persisted significantly longer than other DMARDs with an estimated median of 8.1 yr. Prednisolone was used in up to 50% of RA patients in any one year and has remained fairly constant throughout the study period.Conclusions. Large numbers of individuals with a clinical diagnosis of RA identified from a large primary care database are not receiving DMARDs. This work suggests that many individuals with RA have not been treated appropriately and this may have major long-term consequences on joint damage and general health.