A survey of British rheumatologists’ DMARD preferences for rheumatoid arthritis

[Guest guest]

A survey of British rheumatologists’ DMARD preferences for rheumatoid

arthritis

http://rheumatology.oupjournals.org/cgi/content/abstract/43/2/206

P. Jobanputra1,2, J. 1, K. 2 and A. Burls1

Rheumatology 2004; 43: 206-210

© British Society for Rheumatology 2003; all rights reserved

Abstract

Objective. To determine the current disease-modifying anti-rheumatic

drug (DMARD) preferences of UK consultant rheumatologists.

Methods. A questionnaire was sent in May 2002. We asked which DMARD(s)

was most frequently preferred first and sought the most typical sequence

of DMARDs, including DMARD combinations. Also we determined the extent

to which prognostic and other factors influenced treatment choices.

Comments were invited, written responses abstracted and key themes

identified.

Results. After two mailings, 331 (of 460; 72%) suitable questionnaires

were returned. Ninety-five per cent (315/331) preferred methotrexate

(154, 46.5%) or sulphasalazine (144, 43.5%) or either of these two (17,

5%) as first-choice agent.

Of those who chose methotrexate first, 80% (123/154) ranked

sulphasalazine second, 45% (55/123) combined sulphasalazine and

methotrexate and 49% (27/55) then added hydroxychloroquine to this

combination, in active disease.

Of those who chose sulphasalazine first, 95% (137/144) ranked

methotrexate second, 75% (113/150) preferring methotrexate monotherapy

and 12% (18/150) the combination with sulphasalazine.

Rheumatologists who preferred sulphasalazine first more commonly used

subsequent DMARDs singly than those who started with methotrexate.

Leflunomide was more commonly preferred than intramuscular gold as third

choice (52/145 vs 29/145).

The most popular sequence of DMARDs was methotrexate or sulphasalazine,

singly or in combination, leflunomide, intramuscular gold and

anti-tumour necrosis factor therapy.

Poor prognostic factors influenced DMARD choice, but patient occupation

and drug costs did not.

Conclusion. Methotrexate has displaced other DMARDs, especially

sulphasalazine, as agent of first choice and newer agents have displaced

older DMARDs. Whether the expressed preference for particular DMARDs

accurately reflects actual use, and is optimal in rheumatoid arthritis,

remains to be determined.

1Department of Public Health and Epidemiology, University of Birmingham,

Edgbaston, Birmingham and 2Department of Rheumatology, Selly Oak

Hospital, University Hospital Birmingham NHS Trust, Raddlebarn Road,

Birmingham B29 6JD, UK.

Correspondence to: P. Jobanputra. E-mail: P.Jobanputra@...

[Guest guest]

It was nice to see that a British study has been included in the site. I was

looking at leaving but it has changed my mind. My son is treated at

Birmingham and is on methotrexate and in fact has a routine appointment

tommorrow. He has no been on mtx for over two years and we are hoping as he

hasnt had a flare since last April we can discuss taking him off it.

Ben was diagnosed 4 years ago after a othopeadic surgeon in my local hospital

has him listed as an abused child, but a student paediatrician who had worked

with the Birmingham team questioned his diagnosis and recommended he sent us to

see the team in Birmingham.

If there are anymore people in UK that use this site,could you please contact me

as I have no local contact with other parents.

Many Thanks for all your emails, it really does keep me going

Jane

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A survey of British =?windows-1252?Q?rheumatologists=92_DMARD_?=

=?windows-1252?Q?preferences_for_Rheumatoid Arthritis?=

> A survey of British rheumatologists’ DMARD preferences for rheumatoid

> arthritis

> http://rheumatology.oupjournals.org/cgi/content/abstract/43/2/206

>

> P. Jobanputra1,2, J. 1, K. 2 and A. Burls1

> Rheumatology 2004; 43: 206-210

> © British Society for Rheumatology 2003; all rights reserved

>

> Abstract

>

> Objective. To determine the current disease-modifying anti-rheumatic

> drug (DMARD) preferences of UK consultant rheumatologists.

>

> Methods. A questionnaire was sent in May 2002. We asked which DMARD(s)

> was most frequently preferred first and sought the most typical sequence

> of DMARDs, including DMARD combinations. Also we determined the extent

> to which prognostic and other factors influenced treatment choices.

> Comments were invited, written responses abstracted and key themes

> identified.

>

> Results. After two mailings, 331 (of 460; 72%) suitable questionnaires

> were returned. Ninety-five per cent (315/331) preferred methotrexate

> (154, 46.5%) or sulphasalazine (144, 43.5%) or either of these two (17,

> 5%) as first-choice agent.

>

> Of those who chose methotrexate first, 80% (123/154) ranked

> sulphasalazine second, 45% (55/123) combined sulphasalazine and

> methotrexate and 49% (27/55) then added hydroxychloroquine to this

> combination, in active disease.

>

> Of those who chose sulphasalazine first, 95% (137/144) ranked

> methotrexate second, 75% (113/150) preferring methotrexate monotherapy

> and 12% (18/150) the combination with sulphasalazine.

>

> Rheumatologists who preferred sulphasalazine first more commonly used

> subsequent DMARDs singly than those who started with methotrexate.

>

> Leflunomide was more commonly preferred than intramuscular gold as third

> choice (52/145 vs 29/145).

>

> The most popular sequence of DMARDs was methotrexate or sulphasalazine,

> singly or in combination, leflunomide, intramuscular gold and

> anti-tumour necrosis factor therapy.

>

> Poor prognostic factors influenced DMARD choice, but patient occupation

> and drug costs did not.

>

> Conclusion. Methotrexate has displaced other DMARDs, especially

> sulphasalazine, as agent of first choice and newer agents have displaced

> older DMARDs. Whether the expressed preference for particular DMARDs

> accurately reflects actual use, and is optimal in rheumatoid arthritis,

> remains to be determined.

>

> 1Department of Public Health and Epidemiology, University of Birmingham,

> Edgbaston, Birmingham and 2Department of Rheumatology, Selly Oak

> Hospital, University Hospital Birmingham NHS Trust, Raddlebarn Road,

> Birmingham B29 6JD, UK.

>

> Correspondence to: P. Jobanputra. E-mail: P.Jobanputra@...

>

>

>

>

>

>