The risks of polypharmacy in rheumatoid arthritis

Polypharmacy in RA is associated with increased disease activity, an increased risk of serious adverse events (AEs), and a decreased treatment response.

Results indicate polypharmacy as a potential measure for comorbidity

Polypharmacy in rheumatoid arthritis (RA) is associated with increased disease activity, an increased risk of serious adverse events (AEs), and a decreased treatment response. These were the main conclusions of a study into polypharmacy among patients with RA using data from the French ESPOIR cohort.

Multimorbidity in RA is common. As a consequence, 60% of RA patients are treated with multiple medications. This multicentre, prospective cohort study among French RA patients (n=543) primarily aimed to evaluate the association between polypharmacy and treatment response 1 year after the initiation of the first DMARD treatment, measured via Disease Activity Score (DAS)28-erythrocyte sedimentation rate (ESR) remission scores.

Secondary objectives were to assess treatment response at 5 and 10 years follow-up, investigate the link between polypharmacy and AEs, and examine the association between polypharmacy and the comorbidity indices Rheumatic Disease Comorbidity Index (RDCI) and modified (m)RDCI. Other RA therapy, analgesics, NSAIDs, corticosteroids, and topical treatments were not included in the medication count. The results demonstrated a trend towards a poorer treatment response in the polypharmacy group (≥2 medications, 32.1% reaching DAS28-ESR remission) in comparison with the control group (0-1 medications, 67.9% reached remission).

AEs occurance more frequent in the polypharmacy group

In the adjusted multivariate analysis, no association was found. At 5 and 10 years follow-up, the multivariate analysis did show a significant effect, but only when comorbidity indices were not included. At 10 years follow-up, serious AEs (61/1,000 patient-years) occurred more often in the polypharmacy group (71.4%) than in the control group (57.8%).

Finally, significant correlations were observed between polypharmacy and RDCI scores (r=0.47) and mRDCI scores (r=0.49), respectively. Dr Soraya Benamar (University Hospital of Montpellier, France) concluded that the results indicate that polypharmacy is a potential easy-to-use measure of comorbidity.

Source:
1. Benamar S, et al. Polypharmacy is associated with a poorer treatment response and increased risk of adverse events in early rheumatoid arthritis: Data from French cohort Espoir. OP0098, EULAR 2021 Virtual Congress, 2-5 June.