Tumor necrosis factor inhibitors used for RA at lower threshold

Tumor necrosis factor (TNF) inhibitors are being used for rheumatoid arthritis (RA) more aggressively and at a lower level of disease activity than in the past. Their use is greater in patients with established RA than in those with early RA.

Lee and associates used data from the Consortium of Rheumatology Researchers of North America registry to examine prescribing patterns over 5 years in 11,397 patients receiving RA treatment in the United States. Of these patients, 66% had established RA and 34% had early RA.

About one-third of the patients with RA were receiving TNF inhibitors; 40% had established RA and 25% had early disease. Of those with established RA, 70% were also taking a disease-modifying antirheumatic drug, most often with methotrexate. The use of TNF inhibitors increased 2.8% and 1.2% annually for persons who had established disease and early RA, respectively. Physicians tended to prescribe TNF inhibitors at earlier stages of disease activity for patients who had early and established RA.

The authors noted that their data do not suggest that an alteration in the treatment paradigm has occurred (eg, TNF inhibitor use becoming first-line therapy) but that TNF inhibitors may be used more often and earlier in the future.