Conventional Synthetic Disease-modifying Drugs Remain the Mainstay of Therapy for Rheumatoid Arthritis in India.

Background: There are limited data on the real-world utilization of disease-modifying antirheumatic drugs (DMARDs) in Indian patients with rheumatoid arthritis (RA).

Methods: This was a cross-sectional study of a multicentric observational cohort of RA patients across rheumatology clinics at six centers across India. Patients who met the American College of Rheumatology (ACR) 2010 criteria for RA were included. The demographics, disease-related parameters, and current therapy in terms of DMARDs were analyzed using a structured paper or electronic case record form.

Results: This study included 4,061 patients with RA across six centers in India. A majority were female (female-to-male ratio, 6:1), and their mean [standard deviation (SD)] age at the time of enrollment was 51 (12.2) years. Rheumatoid factor and/or anti-CCP were positive in 79 and 77%, respectively. Data on DMARDs were available for 3,550 RA patients. Conventional synthetic DMARDs alone were being used in 3,289 (93%), targeted synthetic DMARDs in 203 (6%), and biological DMARDs in 67 (2%). A total of at least 18 separate types or combinations of DMARDs were being prescribed, with the most common being a combination of methotrexate and hydroxychloroquine (22%), methotrexate monotherapy (17%), and a combination of methotrexate and leflunomide (16%). Overall, the most common DMARD prescribed (as monotherapy or in combination) was methotrexate (86%), followed by hydroxychloroquine (52%) and leflunomide (37%).

Conclusion: Cs-DMARDs remain the mainstay in the treatment of Indian patients with RA in this study, with the majority being treated with methotrexate alone or in combination with other DMARDs.