In a nutshell
The authors analyzed the occurrence of treatment-related side effects in rheumatoid arthritis (RA) and the factors that cause discontinuation of such treatments.
Some background
In RA, high levels of immune system proteins are generated. This causes inflammation, leading to chronic pain. Disease-modifying antirheumatic drugs (DMARDs) and biological agents (BA) are safe and effective treatments used in patients with RA. DMARDs decrease pain and inflammation, reduce or prevent joint damage, and preserve the structure and function of the joints. However, treatment-related side effects from DMARDs and BA can occur. This is often followed by discontinuation of the treatments. Information about side effects obtained from the standard patient care often vary significantly to that obtained from clinical trials. Therefore, to improve the use of these RA treatments, accurate information on side effects is needed.
Methods & findings
The authors aimed to assess the occurrence of treatment-related side effects in rheumatoid arthritis.
1,202 RA patients were included in this study. All patients previously received DMARDs and/or BA. Side effects reported were mild, moderate or severe. Mild side effects required lowering the treatment dose given. Moderate side effects required drug discontinuation. Severe side effects required hospitalization.
In all, 158 side effects to DMARDs and BA treatment were reported. Out of these, 80.4% required drug discontinuation. Factors independently associated with drug discontinuation were age, shorter duration of disease, severe disability, use of corticosteroids (steroid hormones) and use of combination therapy over single therapy.
Combination treatment of methotrexate (Trexall), leflunomide (Arava) and antimalarial drugs had the highest risk of drug discontinuation. Combination treatment of methotrexate plus BA had a 76% reduced risk of drug discontinuation compared to other combination treatments.
The bottom line
The authors concluded that combination therapy played a critical role in treatment-related side effects in RA. They also found that combination of methotrexate and BA was the safest of all combination treatments.
What’s next?
If you are receiving combination treatment, discuss any concerns on possible treatment-related side effects with your doctor.
Published By :
Seminars in Arthritis and Rheumatism
Date :
Apr 01, 2015
