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Polypharmacy Blunts Responses and Ups the Safety Risks

A study from the British Society for Rheumatology Biologics Register (BSRBR-RA) demonstrates that polypharmacy is a predictor of lower treatment responses and more serious adverse events (SAEs) in rheumatoid arthritis (RA) patients.

A review of this 22,005 RA patients enrolled in a prospective observational cohort study assessed the influence of polypharmacy on the odds of a EULAR 'good response' and the risk of SAE after 12 months of biologic therapy.

They identified the addition of each medication reduced the odds of a EULAR good response by 8% [odds ratios 0.92 (95% CI 0.91, 0.93) P < 0.001] or  3% in an adjusted model [adjusted odds ratios 0.97 (95% CI 0.95, 0.98) P < 0.001].

They also demonstrated a greater effect for polypharmacy than comorbidity on clinical outcomes.

Polypharmacy also contributed to adverse events as each additional medication yielded a 13% increased risk of an SAE [hazard ratio 1.13 (95% CI 1.12, 1.13) P < 0.001] and 6% in the adjusted model [adjusted hazard ratio 1.06 (95% CI 1.05, 1.07) P < 0.001].

There was no difference in SAE risk when comparing polypharmacy and comorbidity.

Physicians should be cognizant of the detrimental effect of polypharmacy on efficacy and safety outcomes in RA patients receiving biologic therapy. 

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

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