VARIATIONS AND TRENDS IN THE PRESCRIPTION OF INITIAL 2ND LINE THERAPYFOR PATIENTS WITH RHEUMATOID-ARTHRITIS

Objective. To evaluate practice variation and time trends in the initi al prescription of second line drugs for the treatment of rheumatoid a rthritis (RA) by a group of selected rheumatologists. Methods. We retr ospectively reviewed medical charts of all patients with a diagnosis o f RA, initially seen between January 1, 1985, and June 30, 1994, by rh eumatologists from a tertiary center and a rheumatology referral clini c in Edmonton. Results. 1427 patients initially seen between 1985 and 1994 were included in the study. Of these, 1244 (87%) received a secon d line drug, 71% within 1.5 years after the disease onset. Overall, an timalarials and parenteral gold were the most frequently prescribed. S tatistically significant trends were observed for the years under stud y. From 1985 to 1987, the most frequently prescribed initial second li ne drug was parenteral gold, between 1988 to 1990, sulfasalazine, and after 1991, antimalarials. Methotrexate was rarely used as a first cho ice. Marked variability was observed among rheumatologists in the use of initial second line drugs. In general, year of prescription and pre scribing rheumatologist were significantly associated with the selecti on of all second line drugs but methotrexate. In addition, disease dur ation and residence (urban or rural) were associated with the selectio n of antimalarials and parenteral gold. Conclusion. Most patients were treated early with second line drugs. Initial prescription patterns v aried among rheumatologists. These patterns have changed over the last 10 years. An increasing trend in the use of antimalarials was noted, and unlike prescription patterns in the US, methotrexate was rarely us ed as the first second line drug.