Changing pattern in the prescription of biological treatment in rheumatoid arthritis. A 7-year follow-up of 1839 patients in southern Sweden

Objective: To study prescription patterns of biological treatment in rheumatoid arthritis ( RA) patients in southern Sweden, a region with no formal or economic restrictions for the use of biological treatment in rheumatological diseases. Specifically, we studied conformity with the national Swedish guidelines for biologics in RA. Methods: Rheumatologists in southern Sweden contribute to a voluntary register on the use of biologics in treating arthritis patients ( the South Swedish Arthritis Treatment Group ( SSATG)). This register covers >90% of all the prescriptions of biologics for arthritis patients in the region. The treatment of 1839 patients ( 2704 treatment occasions) was recorded in the SSATG register during 1999-2006. Baseline characteristics were analysed. Results: Baseline Health Assessment Questionnaire ( HAQ) scores and Disease Activity Scores ( DASs) decreased significantly between 1999 and 2006, but disease activity remained high in RA patients. RA patients were treated with biologics earlier, but only 16% of the patients received biologics within 2 years of disease onset in 2006. The percentage of RA patients who were prescribed biologics after only one previous non-biological DMARD ( disease-modifying anti-inflammatory rheumatic drug) was 27% in 2006. Thirty-five per cent of all RA patients changed from one biological treatment to another. Conclusions: Baseline DASs in RA patients remained high at the start of biological treatment. The national Swedish guidelines for the prescription of biologics in RA were followed. More patients with early RA were treated with biologics. The proportion of RA patients changing from one biological drug to another increased.