Antirheumatic drugs not reaching many patients

Only about 63% of Medicare managed-care patients who have rheumatoid arthritis received recommended low-cost medications that can prevent deformity, study findings indicate.

“Among patients with a true diagnosis of rheumatoid arthritis, closer to 90% should be receiving treatment,” Gabriela Schmajuk, MD, of the division of rheumatology at Stanford University in Stanford, Calif., said in a press release.

Schmajuk and colleagues from several other U.S. sites analyzed 93,143 patients included in the Centers for Medicare and Medicaid Healthcare Effectiveness Data and Information Set from 2005 to 2008 to determine receipt of disease-modifying antirheumatic drugs.

Patients were at least 65 years old and had at least two diagnoses of rheumatoid arthritis within a year. Results have been published in the Feb. 2011 issue of the Journal of the American Medical Association.

The researchers found wide variations in the proportion of patients who received medication, ranging as low as 16% to as high as 87%, based on factors including type of health-care plan, economic status and geographic location.

Age accounted for the largest discrepancies. Patients aged 85 years and older had a 30 percentage-point lower rate of receiving medication compared with patients aged 65 to 69 years (P<.001). Lower percentage point rates were also found among men (-3 points), blacks (-4 points), those with low personal income (-6 points) and those who lived in the lowest zip-code-based socioeconomic regions (-4; P<.001 for all).

Patients enrolled in not-for-profit health plans, and those that lived in the Pacific region of the United States vs. the Middle Atlantic and South Atlantic regions, were more likely to receive medications.

“If left untreated, one-third of patients with rheumatoid arthritis will become disabled within five years of diagnosis,” Schmajuk said.

Although the researchers did not investigate the reasons behind differences in treatment, they speculated that variations regarding when patients can see a specialist, and the availability of rheumatologists within certain health plans might account for some of the discrepancies.

“Given the enormous individual and societal costs associated with rheumatoid arthritis, and increasing substantial evidence that disease-modifying antirheumatic drugs can reduce these costs, variations in disease-modifying antirheumatic drug receipt based on demographics, socioeconomic status and geography are unacceptable,” the researchers wrote.

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