OBJECTIVES: To describe the prescription and use of conventional and biologic disease modifying anti-rheumatic drugs (DMARD) use within one year following a new rheumatoid arthritis (RA) diagnosis.

METHODS: The IBM MarketScan Explorys Claims-EMR Data Set was used to identify adult patients with newly diagnosed RA from 2012-2017; the new diagnosis of RA was the index event. Patients were required to have two RA diagnoses at least 14 days apart, continuous enrollment for one year pre- and post-index, and EMR activity during the one-year follow-up period. Patients with prior RA diagnosis or use of an RA biologic were excluded. The primary outcomes were presence and timing of a prescription claim and/or physician order for a conventional or biologic DMARD.

RESULTS: A total of 2,732 adults met the study inclusion criteria. Overall, 58.1% of patients received a conventional or biologic DMARD within one year of their new RA diagnosis. An additional 4.7% of newly diagnosed patients had a physician order for a DMARD but no corresponding fill or treatment receipt. Overall, 279 (10.2%) patients started a new biologic within one year post-index and an additional 32 patients (1.2%) had a physician order for a biologic DMARD but no corresponding fill. Put differently, 10.3% of newly diagnosed RA patients with a new physician prescription for an RA biologic do not receive that biologic. Of these patients, approximately two-thirds (62.5%) did receive a conventional DMARD, driven by methotrexate (70.0%). Overall, 56.8% of patients used a conventional DMARD and an additional 4.9% had a physician order for a conventional DMARD but no corresponding fill; non-fill rates were similar between methotrexate and the other conventional DMARDs.

CONCLUSIONS: Clinical treatment guidelines recommend early and aggressive treatment of RA, however, one-in-ten patients prescribed a biologic DMARD and one-in-twelve prescribed a conventional DMARD do not receive one.