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Treatment of Early Rheumatoid Arthritis in a Multinational Inception Cohort of Latin American Patients: The GLADAR Experience

Cardiel, Mario H. MD, MSc*; Pons-Estel, Bernardo A. MD; Sacnun, Mónica P. MD; Wojdyla, Daniel MSc; Saurit, Verónica MD§; Marcos, Juan Carlos MD; Pinto, María Raquel C. MD; Cordeiro de Azevedo, Ana Beatriz MD#; da Silveira, Inês Guimarães MD**; Radominski, Sebastião C. MD††; Ximenes, Antônio C. MD‡‡; Massardo, Loreto MD§§; Ballesteros, Francisco MD∥∥; Rojas-Villarraga, Adriana MD¶¶; Oñate, Rafael Valle MD##; Hernandez, Margarita Portela MD***; Esquivel-Valerio, Jorge A. MD†††; García-De La Torre, Ignacio MD‡‡‡; Khoury, Vianna J. MD§§§; Millán, Alberto MD∥∥∥; Soriano, Enrique Roberto MD, MSc¶¶¶; on behalf of GLADAR

JCR: Journal of Clinical Rheumatology:
doi: 10.1097/RHU.0b013e31826d6610
Original Articles
Abstract

Background: Treatment of rheumatoid arthritis (RA) has evolved dramatically in the last decade. However, little is known about the way rheumatologists in Latin America treat their patients in clinical practice, outside the scope of clinical trials.

Objective: The objective of this study was to describe treatment patterns at disease onset in early RA with data from a large, multicenter, multinational inception cohort of Latin American patients.

Methods: Consecutive patients with early RA (<1 year of disease duration as diagnosed by a rheumatologist) from 46 centers in 14 Latin American countries were enrolled in the study. Clinical data, laboratory assessments, and a detailed registry on type of prescriptions were collected at baseline and at 3, 6, 12, 18, and 24 months of follow-up. Hands and feet x-rays were obtained at baseline and at 12 and 24 months. All data were captured in Arthros 6.1 database. Continuous variables were expressed as means and SDs, and categorical variables were expressed as percentages and 95% confidence intervals (95% CIs). Only therapeutic data at baseline are presented, corresponding to the period between disease onset and second visit (3 months).

Results: A total of 1093 patients were included. Eighty-five percent were female, and 76% had a positive rheumatoid factor. Mean age at diagnosis was 46.5 (SD, 14.2) years, and mean disease duration at the first visit was 5.8 (SD, 3.8) months. Between baseline and second visit (3 months), 75% of patients (95% CI, 72%–78%) received disease-modifying antirheumatic drugs. Methotrexate (MTX) alone or in combination was the most frequently used (60.5%), followed by antimalarials (chloroquine or hydroxychloroquine, 32.1%), sulfasalazine (7.1%), and leflunomide (LEF, 4%). In 474 patients (43%), initiation of disease-modifying antirheumatic drugs was within the first month after the first visit. In addition, 290 patients (26%; 95% CI, 23%–29%) received combination therapy as initial treatment. The most frequently used combinations were MTX + chloroquine (45%), MTX + hydroxychloroquine (25%), and MTX + sulfasalazine (16%). Eleven patients (1%; 95% CI, 0.5%–1.8%) received biologics. Sixty-four percent (95% CI, 60%–66%) received corticosteroids. Of those, 80% (95% CI, 77%–84%) received 10 mg of oral prednisone or less.

Conclusions: In this cohort of Latin American patients with early RA, most patients received MTX very early in their disease course. Combination therapy was used approximately in 1 of every 4 patients as initial therapy. Biologics were rarely used at this early stage, and low-dose prednisone was commonly used.

Author Information

From the *Unidad de Investigación “Dr Mario Alvizouri Muñoz,” Hospital General “Dr Miguel Silva,” Morelia, Michoacan, Mexico; †Servicio deReumatología, Hospital Provincial de Rosario, Rosario, Santa Fe; ‡Universidad Nacional de Rosario, Rosario; §Departamento de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba; ∥Departamento de Reumatología, Hospital San Martin de La Plata, La Plata, Buenos Aires, Argentina; ¶Serviço de Reumatologia, Departamento do Aparelho Locomotor, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais; #Serviço de Reumatologia, Departamento de Medicina Interna, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo; **Pontifícia Universidade Católica do Rio Grande do Sul, Departamento da Reumatologia, Porto Alegre, Rio Grande do Sul; ††Disciplina de Reumatologia, Departamento de Clinica Medica, Hospital de Clinicas da Universidade Federal do Paraná, Curitiba, Paraná; ‡‡Hospital Geral de Goiânia Dr Alberto Rassi, Seção de Reumatologia, Goiânia, Goiás, Brazil; §§Departament of Clinical Immunology and Rheumatology, Faculty of Medicine, Pontificia Universidad Católica de Chile; ∥∥Departamento de Reumatología e Inmunología Hospital Clínico San Borja-Arriaran, Santiago, Chile; ¶¶Departamento de Inmunología Clínica y Reumatología, Corporación para Investigaciones Biológicas, Clínica Universitaria Bolivariana, Medellín, Antioquia; ##Departamento de Reumatología e Inmunología, Hospital Militar, Bogotá, Colombia; ***Departamento de Reumatología, Hospital de Especialidades del Centro Medico Nacional Siglo XXI, Ciudad de México; †††Servicio de Reumatología del Departamento de Medicina Interna, Hospital Universitario “Dr José Eleuterio González,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León; ‡‡‡Departamento de Inmunología y Reumatología, Hospital General de Occidente de la Secretaría de Salud, Zapopan, Jalisco, Mexico; §§§Departamento de Reumatología, Clínica Unión Médica, Clínica Corominas, Hospital “Presidente Estrella Urena,” Santiago, Republica Dominicana; ∥∥∥Servicio de Reumatología, Centro Nacional de Enfermedades Reumáticas, Ministerio de Salud, Hospital Universitario de Caracas, Caracas, Venezuela; and ¶¶¶Sección Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires y Fundación Dr Pedro M. Catoggio para el progreso de la Reumatología, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.

This work was supported by an unrestricted grant from Abbott Laboratories. GLADAR was supported by an unrestricted educational grant by Abbott.

The authors declare no conflict of interest.

Correspondence: Enrique Roberto. Soriano, MD, MSc, Sección Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires y Fundación Dr Pedro M. Catoggio para el progreso de la Reumatología, Juan D. Perón 4190 (C1181ACH), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina. E-mail: enrique.soriano@hospitalitaliano.org.ar.

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© 2012 Lippincott Williams & Wilkins, Inc.