Multimorbidity: A barrier to reaching RA treatment targets
medwireNews: Real-world study data suggest that having multiple comorbidities reduces rheumatoid arthritis (RA) patients’ likelihood of achieving low disease activity or remission after initiating a new treatment.
“With the rising prevalence of chronic diseases and multimorbidity worldwide, the development of novel strategies to enhance the management of multimorbid patients with RA is crucial,” say Bryant England (University of Nebraska Medical Center, Omaha, USA) and fellow researchers.
They analyzed data for 21,359 people included in the RISE database in 2016–2018 who had moderate or high RA disease activity according to RAPID3 (n=15,626) or CDAI (n=5733) criteria at two consecutive visits to one of the participating practices, with no new treatment initiated in between.
In the RAPID3 and CDAI cohorts, a respective 15.5% and 18.1% had zero to two comorbidities, as measured using the 46-item medication-based index of chronic conditions, RxRisk, while 31.0% and 30.5% had three to six comorbidities, 27.5% and 26.5% had seven to nine, and 26.0% and 24.9% had 10 or more. Hypertension was the most common comorbidity being treated (57.6–63.8%), followed by congestive heart failure (53.1–59.7%).
Within 90 days of their second visit, 23.4% and 31.1% of patients in the RAPID3 and CDAI cohort, respectively, initiated a new DMARD treatment, most commonly a tumor necrosis factor inhibitor (9.9 and 12.7%).
As reported in Arthritis Care & Research, the number of comorbidities was not significantly associated with the likelihood of initiating a new treatment. But among patients who did start a new DMARD, those with a lot of comorbidities were less likely to achieve low disease activity or remission than those with only a few, with the odds declining by a significant 5–6% with each additional comorbidity.
Indeed, patients in the RAPID3 cohort with 10 or more comorbidities were a significant 46% less likely to achieve low disease activity or remission than those with up to two comorbidities. For those in the CDAI cohort, the likelihood was reduced a nonsignificant 35%.
England and co-authors conclude: “These findings from a large, real-world registry illustrate the potential impact of multimorbidity on treatment response and indicate that a more holistic management approach targeting multimorbidity may be needed to optimize RA disease control in these patients.”
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