Polypharmacy is associated with treatment response and serious adverse events: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis.

Authors:
Katie Bechman
Katie Bechman
King's College London
United Kingdom
Mark Yates
Mark Yates
University of South Alabama
United States
Elena Nikiphorou
Elena Nikiphorou
St Albans City Hospital
United Kingdom
Mariam Molokhia
Mariam Molokhia
London School of Hygiene and Tropical Medicine
United Kingdom
Sam Norton
Sam Norton
University of Hertfordshire
United Kingdom
Andrew P Cope
Andrew P Cope
King's College London

Rheumatology (Oxford) 2019 Apr 14. Epub 2019 Apr 14.

Department of Inflammation Biology, School of Immunology & Microbial Sciences.

Objective: To evaluate whether polypharmacy is associated with treatment response and serious adverse events (SAEs) in patients with RA using data from the British Society for Rheumatology Biologics Register (BSRBR-RA).

Methods: The BSRBR-RA is a prospective observational cohort study of biologic therapy starters and a DMARD comparator arm. A logistic regression model was used to calculate the odds of a EULAR 'good response' after 12 months of biologic therapy by medication count. Cox proportional hazards models were used to identify risk of SAEs. The utility of the models were compared with the Rheumatic Disease Comorbidity Index using Receiver Operator Characteristic and Harrell's C statistic.

Results: The analysis included 22 005 patients, of which 83% were initiated on biologics. Each additional medication reduced the odds of a EULAR good response by 8% [odds ratios 0.92 (95% CI 0.91, 0.93) P < 0.001] and 3% in the adjusted model [adjusted odds ratios 0.97 (95% CI 0.95, 0.98) P < 0.001]. The Receiver Operator Characteristic demonstrated significantly greater areas under the curve with the polypharmacy model than the Rheumatic Disease Comorbidity Index. There were 12 547 SAEs reported in 7286 patients. Each additional medication equated to 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]. Predictive values for SAEs were comparable between the polypharmacy and Rheumatic Disease Comorbidity Index model.

Conclusion: Polypharmacy is a simple but valuable predictor of clinical outcomes in patients with RA. This study supports medication count as a valid measure for use in epidemiologic analyses.

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Source
http://dx.doi.org/10.1093/rheumatology/kez037DOI Listing
April 2019
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