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Variations in First Biologic Use in Rheumatoid Arthritis

A Canadian analysis shows that rheumatoid arthritis (RA) patients are more likely to receive biologic DMARDs earlier if they are younger, female, and living in urban areas closer to prescribers. However usage patterns were not uniform across patients and prescribers given similar disease characteristics in a population with identical health insurance coverage. 

Physician preference was strongly associated with differences in time from first conventional synthetic DMARD to first biologic DMARD.

Factors governing a physicans choice of first biologic therapy in RA are numerous but vague as there are many to consider - physician experience, patient preference, their payer limitations, costs, toxicities and individual clinical scenarios.  Despite variations in physician use, there is little evidence that one biologic is superior to another when starting biologic therapy in RA.

All RA patients in Canada have identical comprehensive health insurance coverage, making it an ideal setting to study this issue.  This cohort RA study used administrative data and patient-level data on 17672 older RA patients from Ontario, Canada seen between 2002 and 2015, and who had received at least 1 csDMARD. 

Those more likely to have delays in receiving a biologic were the elderly , males, and distance from the nearest rheumatologist (HR per 10-km increase, 0.99; 95% CI, 0.98-0.99; P < .001).

Biologics were prescribed primarily by rheumatologists (71%) and less so by primary care physicians (12%).  A total of 214 unique prescribers had written 10 or more biologic prescriptions during the study period. Older p

Since the introduction of biologic therapies rheumatologists’ preferences (ie, yearly prescription rates) increased over time, from 1.7% in 2001 to 4.9% in 2015. Older physicians and those in rural areas were less likely to prescribe a first time biologic.

After adjusting for calendar year, patient, prescriber, and region, there was considerable variation between prescribers in of prescribing a first biologic DMARD (65% variance).  The reasons for this variation were not available from these data sets. 


The author has no conflicts of interest to disclose related to this subject

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