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Table 2 Adjusted odds ratio (95% CI) of initiation or switching biologic DMARDs

From: Factors associated with initial or subsequent choice of biologic disease-modifying antirheumatic drugs for treatment of rheumatoid arthritis

  Biologic DMARD initiation among patients with early untreated RA Biologic DMARD initiation among patients with prevalent RA Switching of biologic DMARDs among biologic DMARD users
Total number 78,667 (100%) 93,534 (100%) 23,232 (100%)
Biologic DMARD initiation/switch, n 3873 (4.9%) 10,361 (11.1%) 2761 (11.9%)
Data source
 United vs. Medicaid 1.87 (1.70, 2.05) 1.13 (1.06, 1.20) 0.92 (0.81, 1.05)
Age (by 10-year increase) 0.87 (0.84, 0.89) 0.81 (0.79, 0.83) 0.87 (0.84, 0.91)
Gender
 Male vs. female 0.90 (0.83, 0.98) 0.95 (0.89, 1.00) 0.87 (0.79, 0.97)
Comorbid conditions in prior year
 Hyperlipidemia 0.90 (0.83, 0.97) 0.97 (0.92, 1.03) 1.02 (0.91, 1.13)
 Heart disease 0.92 (0.82, 1.03) 1.02 (0.94, 1.10) 1.12 (0.96, 1.31)
 Hypertension 0.85 (0.78, 0.94) 0.91 (0.86, 0.97) 0.94 (0.83, 1.06)
 Cerebrovascular accident 0.91 (0.76, 1.08) 0.94 (0.83, 1.06) 1.21 (0.92, 1.57)
 Diabetes mellitus 0.93 (0.83, 1.04) 1.01 (0.93, 1.09) 0.95 (0.80, 1.12)
 Obesity 1.02 (0.92, 1.12) 0.98 (0.91, 1.06) 0.99 (0.85, 1.16)
 Inflammatory bowel disease 1.89 (1.56, 2.30) 1.22 (1.06, 1.42) 0.71 (0.56, 0.89)
 Hospitalization with severe infection 0.82 (0.67, 1.00) 1.03 (0.91, 1.16) 0.86 (0.66, 1.11)
 COPD 0.80 (0.74, 0.87) 0.97 (0.92, 1.02) 1.06 (0.95, 1.18)
 Liver disease 1.16 (1.01, 1.33) 1.16 (1.05, 1.29) 1.03 (0.84, 1.27)
 Metastatic cancer 0.92 (0.61, 1.39) 0.94 (0.68, 1.29) 0.29 (0.10, 0.81)
 Any tumor 1.01 (0.87, 1.17) 0.93 (0.84, 1.03) 0.98 (0.79, 1.22)
 Alcohol abuse 0.77 (0.64, 0.93) 0.94 (0.82, 1.09) 0.75 (0.53, 1.06)
 Tobacco use 1.01 (0.92, 1.10) 1.13 (1.06, 1.20) 1.03 (0.92, 1.17)
 Combined comorbidity score 0.96 (0.93, 0.98) 0.95 (0.94, 0.97) 1.01 (0.97, 1.05)
History of medication use in prior year
 Non-statin lipid-lowering drugs 1.10 (0.94, 1.27) 1.13 (1.02, 1.25) 1.04 (0.86, 1.25)
 Statins 1.03 (0.93, 1.15) 1.02 (0.96, 1.10) 0.89 (0.77, 1.02)
 ACE inhibitors 1.08 (0.97, 1.20) 1.00 (0.94, 1.07) 0.96 (0.84, 1.09)
 ARBs 0.98 (0.85, 1.13) 1.10 (1.01, 1.20) 1.06 (0.90, 1.25)
 Beta blockers 0.91 (0.81, 1.02) 0.91 (0.85, 0.97) 0.94 (0.83, 1.07)
 Calcium channel blockers 0.88 (0.78, 0.99) 0.92 (0.86, 0.99) 0.90 (0.78, 1.04)
 Diuretics 1.16 (1.06, 1.28) 1.01 (0.96, 1.08) 1.09 (0.97, 1.22)
 Insulin 1.55 (1.28, 1.87) 1.36 (1.20, 1.53) 1.04 (0.81, 1.34)
 Oral hypoglycemic drugs 1.23 (1.06, 1.43) 1.05 (0.95, 1.15) 0.98 (0.80, 1.20)
 Aspirins 0.99 (0.82, 1.19) 0.83 (0.73, 0.94) 0.75 (0.55, 1.01)
 Coxibs 1.46 (1.32, 1.61) 1.30 (1.23, 1.38) 1.11 (1.00, 1.23)
 Non-selective NSAIDs 1.30 (1.20, 1.39) 1.07 (1.02, 1.12) 1.12 (1.03, 1.22)
 Opioids 1.18 (1.09, 1.27) 1.19 (1.13, 1.25) 1.21 (1.10, 1.34)
 Steroid daily dosage
  None Reference Reference Reference
  Low (<5 mg/day) 2.42 (2.25, 2.60) 1.65 (1.57, 1.73) 1.52 (1.38, 1.68)
  Medium (5–10 mg/day) 3.12 (2.56, 3.80) 1.89 (1.76, 2.04) 1.53 (1.34, 1.75)
  High (≥10 mg/day) 2.61 (1.91, 3.57) 1.72 (1.55, 1.89) 1.81 (1.51, 2.15)
 Number of non-biologic DMARDs
  None Reference Reference
  One 1.54 (1.42, 1.66) 1.44 (1.27, 1.64)
  More than one 2.40 (2.17, 2.67) 1.98 (1.65, 2.36)
 Prior MTX 1.79 (1.69, 1.90) 0.78 (0.70, 0.87)
 Prior HCQ 0.57 (0.54, 0.61) 0.75 (0.65, 0.86)
Healthcare utilization in prior year
 Number of prescriptions 0.97 (0.97, 0.98) 0.99 (0.98, 0.99) 1.01 (1.00, 1.02)
 Number of physician visits 1.00 (1.00, 1.01) 1.00 (1.00, 1.01) 1.01 (1.00, 1.01)
 Number of hospitalizations 1.02 (0.97, 1.06) 1.05 (1.02, 1.08) 0.98 (0.92, 1.05)
 Number of emergency room visits 0.98 (0.96, 1.00) 0.97 (0.95, 0.98) 1.00 (0.97, 1.02)
  1. Odds ratios were adjusted for demographics, data source, calendar year, comorbidities, history of medication use, and healthcare utilization in the baseline period. RA rheumatoid arthritis, DMARD disease-modifying antirheumatic drug, COPD chronic obstructive pulmonary disease, ACE angiotensin-converting enzyme, ARB angiotensin II receptor blocker, Coxib Cyclooxygenase inhibitor, NSAID non-selective non-steroidal anti-inflammatory drug, MTX methotrexate, HCQ hydroxychloroquine