Prescribers More Likely to Escalate to Biologics than Triple DMARD Therapy Save

The paradigm for DMARD use in rheumatoid arthritis (RA) begins with DMARD monotherapy and then escalates to combination therapy with either DMARDs or a combination of conventional DMARD plus a biologic DMARD (bDMARD).  Recent data suggests equal efficacy for triple DMARD therapy when compared to methotrexate (MTX) plus a TNF inhibitor.

Sparks et al used insurance claims records to assess how often RA therapy is escalated to either triple therapy or bDMARD.  They analyzed 24,576 patients and noted that 11.1% intensified treatment to bDMARD compared to 0.7% who intensified to triple therapy.

Those on triple DMARD therapy used more steroids and NSAIDs and were more likely to be older, from certain geographic regions (i.e., Western US) and had few outpatient visits.

Thus, triple therapy use was 15 times less likely than escalation to biologic DMARDs, even though recent research (e.g., TEAR, RACAT studies) suggests equal efficacy.