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Management of Rheumatoid Arthritis in Germany – Findings of a
Claims Database Analysis

Hagenmeyer EG1, Gothe H1, Höer A1, Runge C2, Häussler B1 1 IGES – Institute for Healthcare and Social Research GmbH, Berlin, Germany; 2Wyeth Pharma, Ltd., Muenster, Germany Figure 3: Sick leaves and hospitalisations in patients prior to TNF-α Objectives
inhibitors therapy and all enrolees with RA Rheumatoid Arthritis (RA) imposes a significant burden of disease to Prevalence of Rheumatoid Arthritis both affected patients and the society as a whole. We performed the first Out of the 728,111 beneficiaries continuously enrolled between 2000 and 2004 Enrolees with RA prior to initiation of TNF- α
German claims database analysis among members of a German health n = 5,850 (mean age: 43 ± 14 years) fulfilled the inclusion criteria for RA.
insurance fund to estimate RA treatment prevalence, to describe All enrolees with RA
prescription patterns and assess overall disease burden.
The total number of women in the study population was n = 2,847 (mean age: er year
50 ± 14 years), the number of men was n = 3,003 (mean age: 48 ± 12 years).
RA treatment prevalence for the year 2004, standardized by age and sex to the general German population was 0.68 % for men and 1.25 % for women or er 100 en

We based our analysis on billing data from the years 2000 to 2004 of a German sickness fund covering 1.5 million beneficiaries. RA patients Treatment with traditional DMARDs or TNF-α inhibitors were identified by either inpatient or sick leave records due to ICD-10 In total 42.6 % of the patients with RA received a disease modifying therapy, codes (seropositive rheumatoid arthritis, other rheumatoid arthritis) or at 38.2 % of the male and 47.3% of the female patients respectively. 42.6% of least two prescriptions of a disease-modifying drug (Figure 1). In the Sick leaves
patients had a therapy with traditional DMARDs and 3.0% with TNF-α inhibitors.
disease modifying agents used for therapy of RA we distinguished Figure 2 shows the distribution of disease modifying drugs in RA patients, MTX traditional disease-modifying antirheumatic drugs (traditional DMARDs, and SSZ being the most frequently used agents (Figure 2).
i.e. Anakinra, antimalaria drugs as Chloroquine and Hydroxychloroquine,Penicillamine, Gold, Leflunomide, Methotrexate (MTX), Sulfasalazine The RA treatment prevalence described in this study corresponds (SSZ)) and TNF-α inhibitors (Adalimumab, Etanercept, Infliximab).
with European cross-sectional population studies that found combined prevalence rates for RA of 0.5 % to 1.1 % and a female to When identifying RA patients from prescriptions of disease-modifying male excess of around 2 times (Silman and Hochberg 2001).
drugs, we excluded cases with a variety of diagnoses that are also indications for traditional DMARD or TNF-α inhibitors therapy, e.g.
Compared to the prevalence of treatment with TNF-α inhibitors in the psoriasis, ankylosing spondylitits, Crohn´s disease, scleroderma, patients of the national database of the German Collaborative systemic lupus erythematosus and malignant disease.
Arthritis Centers, a register of patients in rheumatology specialist care (8.6 %, Zink et al. 2006), the prevalence in the patients from We specified treatment prevalence and patterns of RA disease our statutory sickness fund population is considerably lower (3.0 %).
management with traditional DMARDs and TNF-α inhibitors in the This difference can be explained with a selection bias, which is stronger in specialist care data than in our statutory sickness fund We specified subpopulations with a newly started therapy of either traditional DMARDs or TNF-α inhibitors. The condition for the initiation of As less than half of RA-patients had a prescription of a disease a therapy was defined by the identification of an index prescription of the modifying therapy, this may indicate that therapeutic standards are particular agent without any precedent prescription of the same agent during 365 days before the index date.
Internal medicine specialists prevail as the prescribing specialty as Figure 1: Rheumatism patients’ selection workflow well for traditional DMARDs as for TNF-α inhibitors. An important percentage of all traditional DMARD therapies (25 %) and all TNF-α Total population of the sickness fund
TNF-α inhibitors Other DMARDs
inhibitors (10 %) is initiated by general practitioners.
TNF-α inhibitors
Included population of beneficiaries
The high number of sick leaves and hospitalizations in RA patients age >= 18 years, continuously enrol ed 2001 to 2004 Specialty Prescribing Disease Modifying Therapy prior to initiation of TNF-α inhibitor therapy indicates that thesebiologicals are mainly prescribed in a high burden RA In 58% of RA patients traditional DMARD therapy was initiated by an internal medicine specialist, in 25% by a general practitioner, in 6% by rheumatology selection
clinics and in 10% by other disciplines.
TNF-α inhibitor therapy was initiated in 69% of RA patients by an internal medicine specialist, in 10% by a general practitioner, in 19% by rheumatology Silman AJ, Hochberg MC (eds). Epidemiology of the Rheumatic Diseases Second Edition. Oxford: Oxford University Press, 2001.
clinics and in 2% by other disciplines.
Zink A, Huscher D. The National Database of the German Arthritis Centres – 12 selection
Sick Leaves and Hospitalizations in Patients with Rheumatoid Arthritis ear balance. Z Rheumatol 2006, 65:144-151.
RA patients with
RA patients with
RA patients with
diagnosis of RA from
prescriptions of
prescriptions of
Compared to the RA population as a whole RA patients receiving TNF-α sick leave or
traditional DMARDs
TNF-α inhibitors
inhibitors were characterized by a 2.6 fold number of sick leaves (25.8 per 100 IGES-Institute for Healthcare and Social Research GmbH hospitalization
enrolees compared to 9.8) and a 6.4 fold number of hospitalizations (45.3 per Total population of patients with RA
100 enrolees compared to 7.1) in the year prior to therapy initiation (Figure 3).
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