Second-line therapy with biological drugs in rheumatoid arthritis patients in German rheumatologist practices: a retrospective database analysis.

The aim of the study was to assess the proportion of German patients with rheumatoid arthritis (RA) who received biological disease-modifying antirheumatic drugs (DMARDs) after initiation of conventional DMARD therapy. Patients aged 18 years or over who had initiated therapy with a conventional DMARD in a rheumatic care practice between 2009 and 2013 were included (IMS LRx database). The main outcome was the first prescription of a biological DMARD within 5 years following the index date. A multivariate Cox regression model was adopted to predict the prescription of biological DMARDs on the basis of patient characteristics. The mean age of the 137,673 patients with RA was 57.8 years (SD = 15.0). 68.3 % of the subjects were women. Most patients started their conventional DMARD therapy with methotrexate (62 %), sulfasalazine (13 %), and hydroxychloroquine (12 %). 20.7 % of the RA patients were given a biological DMARD within 5 years following the index date. Male gender was linked with a 10 % higher likelihood of biologic use whereas age decreased the odds of biological DMARD prescription by 3 % per year. Finally, leflunomide use was associated with increased odds of biologic prescription, whereas sulfasalazine and hydroxychloroquine decreased the chances of receiving biologics, as compared to methotrexate. Around 20 % of patients were being treated with biologics 5 years after prescription of conventional DMARDs. Gender, age, and initial treatment impacted the proportion of subjects treated with biological DMARDs.