The initiation of biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) among patients with newly diagnosed rheumatoid arthritis varies widely with age and ethnicity, researchers have found.
In a new study in England and Wales led by King’s College London (KCL), older patients and patients with Asian heritage were found to be missing out on effective treatments.
The researchers showed that patients over 65 years of age were 60% less likely to be given highly effective biological and targeted synthetic DMARDs to treat symptoms compared to patients aged under 40. Asian women were also less likely to be prescribed these drugs than Asian men and white men.
Socioeconomic status, other health conditions, or the response to conventional treatments did not explain the differences, the researchers said.
Using data from the National Early Inflammatory Arthritis Audit (NEIAA), the researchers identified 6,098 patients enrolled in the audit between May 2018 and April 2022 who had rheumatoid arthritis and 12-month follow-up data available.
Statistical methods were used to examine whether factors such as age, sex, ethnicity, health and economic status were associated with the initiation of biological and targeted synthetic DMARDs within 12 months of initial rheumatology assessment.
The mean age of the patients was 59.2 years, and just under two-thirds were women. The majority of the participants were white (86.2%), 2.5% were Black, 7.9% were Asian and 3.3% were mixed or other ethnicities.
Within 12 months of initial diagnosis, 8.3% of patients started biological and targeted synthetic DMARDs. Patients under 40 were nearly two and half times more likely to start treatment than patients who were over 65 (multivariable-adjusted risk ratio 2.41 [95% CI 1.83–3.19]; p<0.0001), and Asian women were about half as likely to start treatment than white individuals (0.52 [0.36–0.76]; p=0.0007).
The study also found that Black individuals were more likely to be started on biological and targeted synthetic DMARDs than white individuals (1.54 [1.10–2.16]; p=0.012), which was at least partly explained by worse disease severity at diagnosis in these individuals.
The findings highlight the problems of a ‘one-size-fits-all’ approach to treatment and the need for personalised information to be considered. The researchers say equitable access to biological and targeted synthetic DMARDs and quality care for underserved groups is needed.
Lead author Dr Mark Russell, NIHR clinical lecturer in rheumatology at King’s College London, said: ‘Rheumatoid arthritis is a progressive, debilitating condition with no cure. This study highlights marked differences in who gets started on advanced therapies for rheumatoid arthritis.
‘Access to these drugs in England and Wales is defined by need. Despite this, we found that Asian women and older adults were far less likely to be initiated on these treatments. Biologics are incredibly effective at improving quality of life and preventing complications from rheumatoid arthritis.
‘It is therefore crucial to develop a better understanding of what underlies these disparities if we are to ensure all patient groups receive equitable access to the best available care.’
Reference
Russell, M et al. Factors associated with biological and targeted synthetic disease-modifying antirheumatic drug initiation for rheumatoid arthritis in underserved patient groups in England and Wales, UK: a national cohort study. The Lancet Rheumatology 2024; Oct 15: DOI: 10.1016/ S2665-9913(24)00221-2.
