High Levels of Polypharmacy in Rheumatoid Arthritis—A Challenge Not Covered by Current Management Recommendations: Data From a Large Real-Life Study

Abstract

Background: Rheumatoid arthritis (RA) is associated with high frequency of comorbidities and increased risk of polypharmacy. Although there is a great potential for complications, there is a gap in literature on polypharmacy in patients with rheumatic arthritis. Objective: To evaluate the prevalence and factors associated with polypharmacy in a population in a real-life setting. Methods: A cross-sectional multicenter study was conducted in Brazil. Patients underwent clinical evaluation and medical records analysis. Polypharmacy was considered as a dependent variable. To test independent variables, we used Poisson regression. Results: We evaluated 792 patients (89% female, median age 56.6 years). Median duration of disease was 12.7 years, 78.73% had a positive rheumatoid factor. The median of disease activity score-28 was 3.5 (disease with mild activity), median of the clinical disease activity index score was 9, and median of health assessment questionnaire-disability index was 0.875; 47% used corticosteroids, 9.1% used nonsteroidal anti-inflammatory drugs, 90.9% used synthetic disease-modifying antirheumatic drugs, 35.7% used biologic disease-modifying antirheumatic drugs (DMARDs). In total, 537 (67.9%) patients used 5 or more drugs. Polypharmacy showed a relationship with a number of comorbidities and use of specific drugs (corticosteroids, methotrexate, and biological DMARDs). Conclusion: We found a high prevalence of polypharmacy (67.9%) in RA. Solutions to management this problem should be stimulated.

Polypharmacy in Middle-European Rheumatoid Arthritis-Patients: A Retrospective Longitudinal Cohort Analysis With Systematic Literature Review

“…This observational study shows polypharmacy (defined as ≥5 medications) in 33.7% of RA-patients, especially in female patients older than 50 years. This number is low in comparison with current literature, reporting polypharmacy in as many as 44.4 to 67.9% of all RA-patients (19,21,22). The reason for this difference may be differences of the insurance systems, or the fact that definitions used for polypharmacy are still not consistent (2, 6).…”

“…The reason for this difference may be differences of the insurance systems, or the fact that definitions used for polypharmacy are still not consistent (2, 6). In the systematic literature review, the definition of more than 5 drugs was applied in one trial (22), the definitions of more than 3 drugs in another one (6), while all other studies did not provide a specific definition used. In order to make observations and documentations more comparable throughout the literature, a consensus will be helpful for the future.…”

“…Some of these studies showed that 45.1% of RA-patients have additional comorbidities, and 61.6% of all RA-patients are affected with polypharmacy (Table 2). Polypharmacy was significantly associated with comorbidities and the use of corticosteroids, MTX and bDMARDs (22). Additional aspects were that polypharmacy had a negative impact on health-related quality of life (19), is common also in hospitalized RA-patients (16) with specific RA-medications increasing between 1978 and 1995 (17).…”

“…A mean of 2.8 comorbidities and side effects of RA is reported in 2 studies, and considered responsible for polypharmacy and drug-to-drug interactions (20,22). More specifically, increasing numbers of comorbidities have been related to the number of drugs (20), with a significant correlation with a standardized regression weight of 0.54 in another study (6).…”

Special Considerations in Geriatric Populations

“…Studies in rheumatoid arthritis cohorts show that patients with rheumatoid arthritis tend to have polypharmacy (median number of drugs approximately 5) and, further, that older age tends to increase the risk for polypharmacy (65,66). Other studies have also shown polypharmacy to be a predictor of adverse outcomes in rheumatoid arthritis (67).…”