A survey of British rheumatologists' DMARD preferences for rheumatoid arthritis

[Guest guest]

Rheumatology (Oxford). 2003 Aug 15

A survey of British rheumatologists' DMARD preferences for rheumatoid

arthritis.

Jobanputra P, J, K, Burls A.

Department of Public Health and Epidemiology, University of Birmingham,

Edgbaston, Birmingham, UK; Department of Rheumatology, Selly Oak Hospital,

University Hospital Birmingham NHS Trust, Raddlebarn Road, Birmingham B29

6JD, UK.

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 (P < 0.0001). Leflunomide was more

commonly preferred than intramuscular gold as third choice (52/145 vs

29/145; P < 0.003). 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.

PMID: 12923291 [PubMed - as supplied by publisher]

[Guest guest]

Hi Jane,

I'm down on the Kent/London border and my son has had systemic JIA for

around (crikey) 8 years now. He is treated at Gt Ormond St Hospital. He's on

(mainly) infliximab and methotrexate and doing very well these days. I've

met Prof. Southwood who used to head up the Rheumy team at Birmingham. Is

his team treating Ben?

Regards,

Oliver

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@...

>

>

>

>

>

>

[Guest guest]

Hi, Jane. Glad you decided to hang around. How amazing that the dr

diagnosed child abuse and a student dr steered you in the right

direction. Thank goodness for that. Sorry, I am not from the UK but I do

believe there are others who are. Perhaps they'll chime in soon. Good

luck with tapering off the MTX. Let us know how it goes. Michele

(16,pauci & spondy)

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@...

>

>

>

>

>

>