Temporal and regional variation in the use of biologic and targeted synthetic DMARDs for rheumatoid arthritis: a nationwide cohort study
Authors' conclusion
There is marked variation in escalation to b/tsDMARDs for people newly diagnosed with RA throughout England and Wales, despite a universal health-care system.
Study context
- Population
- People with RA enrolled in the National Early Inflammatory Arthritis Audit (NEIAA), England and Wales, May 2018 to April 2022, with 12-month follow-up datawith available follow-up
- Participants
- 6,098 people
- Exposure
- b/tsDMARD initiation across time periods, regions and hospitals
- Outcome
- Escalation to b/tsDMARDs within 12 months of initial rheumatology assessment
- Follow-up
- 12 months
Methodological detailsnationwide, case-mix-adjusted mixed-effects regression, before vs after national guideline publication (July 2021)
- Nationwide
- Case-mix-adjusted mixed-effects regression
- Before vs after national guideline publication (July 2021)
Main finding
As reported in the abstract
b/tsDMARD initiation within 12 months of initial assessment
- Patients initiating b/tsDMARDs
- 508 (8.3%)
- b/tsDMARD escalation in May 2021/22 (increased marginally towards end of study period)
- 9.2%
- Regional proportion escalated, Wales (lowest)
- 5.1%
- Regional proportion escalated, North-West England (highest)
- 10.7%
- Case-mix-adjusted intraclass correlation (ICC) for hospitals within regions
- 0.17
- Case-mix-adjusted between-region ICC
- 0.0
Observational data: associations, not effects.
Original publication
Temporal and regional variation in the use of biologic and targeted synthetic DMARDs for rheumatoid arthritis: a nationwide cohort study. Rheumatology (Oxford). Published 1 November 2024. doi:10.
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