Veterans with rheumatoid arthritis were significantly more likely to be persistent and adherent to a tumor necrosis factor inhibitor (TNFi) plus methotrexate combination therapy than to triple therapy with non-biologic disease-modifying antirheumatic drugs (DMARDs), a study published in Arthritis Care & Research concluded. 

Brian C. Sauer, PhD, MS, VA Medical Center Salt Lake IDEAS Center, Salt Lake City, UT, and colleagues set out to compare the persistence and adherence to triple therapy with non-biologic DMARDs methotrexate, hydroxychloroquine, and sulfasalazine, vs. a TNFi plus methotrexate in patients with rheumatoid arthritis. The team evaluated administrative and laboratory data for U.S. veterans with rheumatoid arthritis starting triple therapy or TNFi + methotrexate between January 2006 and December 2012. 

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Treatment persistence was measured by 3 definitions: 1) no gap in therapy of ≥90 days for any drug in the original combination, 2) no added or switched DMARD and no decrease to non-biologic DMARD monotherapy, and 3) similar to Definition 2 but allowing a switch to another agent in the same drug class. Adherence was the proportion of days covered of ≥80%. 

In the analysis (n=4,364), patients in the TNFi + methotrexate group were significantly more likely than patients in the triple therapy group to meet all persistence criteria in Definition 1 (risk difference [RD]: 13.1%, 95% CI: 9.2%, 17.0%); Definition 2 (RD: 6.4%, 95% CI: 2.3%, 10.5%), and Definition 3 (RD: 9.5%, 95% CI: 5.5%, 13.6%). Patients in the TNFi + methotrexate group also showed higher adherence during the first year (RD: 7.2%, 95% CI: 3.8%, 10.5%). 

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