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