The risks of polypharmacy in RA

Polypharmacy in rheumatoid arthritis (RA) is associated with high disease activity, an increased risk of serious adverse events (AEs), and a decreased treatment response. These were the main conclusions of a study among patients with RA using data from the French ESPOIR cohort. Moreover, the results indicated that polypharmacy is a potential measure for comorbidity [1].

Multimorbidity in RA is common and, as a consequence, 60% of RA patients are treated with multiple medications. Previous research has linked polypharmacy among RA patients to an increased risk of hospitalisation, increasing numbers of AEs, and a hampered treatment response [2-4]. This multicentre, prospective cohort study among French RA patients (n=543) primarily aimed to evaluate the association between polypharmacy and treatment response 1 year after the initiation of the first DMARD treatment, measured via Disease Activity Score (DAS)28-erythrocyte sedimentation rate (ESR) remission scores [1]. Secondary objectives were to assess treatment response at 5 and 10 years of follow-up, investigate the link between polypharmacy and AEs, and examine the association between polypharmacy and the comorbidity indices Rheumatic Disease Comorbidity Index (RDCI) and modified (m)RDCI. Polypharmacy included all speciality medication, except for other RA therapy, analgesics, NSAIDs, corticosteroids, and topical treatments.

The results demonstrated a trend towards a worse treatment response in the polypharmacy group (≥2 medications, 32.1% reaching DAS28-ESR remission) in comparison with the control group (0–1 medication, 67.9% reached remission; P=0.07). In the adjusted multivariate analysis, no association was found. The multivariate analysis showed a significant effect at 5 years (OR 0.60; 95% CI 0.38–0.94; P=0.03) and 10 years (OR 0.44; 95% CI 0.26–0.77; P=0.004) follow-up but only when comorbidity indices were not included. At 10 years follow-up, serious AEs (61/1,000 patient-years) occurred more often in the polypharmacy group (71.4%) than in the control group (57.8%; P=0.03). Finally, significant correlations were observed between polypharmacy and RDCI scores (r=0.47; P<0.01) and mRDCI scores (r=0.49; P<0.01), respectively. Dr Soraya Benamar (University Hospital of Montpellier, France) explained that these results are in accordance with recent trials investigating polypharmacy in RA. Furthermore, Dr Benamar suggested that polypharmacy is a potential easy-to-use measure of comorbidity. Future studies are needed to explore this option.

1. Benamar S, et al. Polypharmacy is associated with a poorer treatment response and increased risk of adverse events in early rheumatoid arthritis: Data from French cohort Espoir. OP0098, EULAR 2021 Virtual Congress, 2–5 June.
2. Filkova et al. J Rheumatol. 2017; 44(12):1786-93.
3. Ma et al. Ther Clin Risk Manag. 2019; 15:505-24.
4. Bechman et al. Rheumatology. 2019;58(10):1767-76.

 

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Posted on 2 August 20213 August 2021