FRI0046 POLYPHARMACY: A RARELY-DISCUSSED PROBLEM IN RHEUMATOID ARTHRITIS. DATA FROM A LARGE REAL-LIFE STUDY
Authors: Ana Paula Gomides, Cleandro Albuquerque, Ana Beatriz Vargas-Santos, Claiton Brenol, Ivanio Pereira, Karina Bonfiglioli, Manoel Bertolo, Maria Raquel Pinto, Maria de Fátima Sauma, Paulo Louzada, Rina Giorgi, Sebastiao Radominski, Licia Mota, Geraldo Castelar
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Polypharmacy is concomitant use of five or more drugs and is usually associated with various comorbidities and advanced age. The already demonstrated consequences of polypharmacy are increased side effects, drug interactions, increased hospitalizations, drug handling difficulties, reduced adherence, and even increased mortality. Rheumatoid arthritis (RA) is a chronic systemic disease with preferential involvement between the third and fifth decades. Owing to treatment of underlying disease and comorbidities, patients with RA frequently require combined use of several drugs. Despite the possible negative consequences of polypharmacy in RA, there is a shortage of studies in literature. <h3>Objectives:</h3> Evaluate prevalence and factors associated with polypharmacy in patients with RA in a real-life setting. <h3>Methods:</h3> This is a cross-sectional part of the Rheumatoid Arthritis in Real Life (REAL) study that analyzed RA patients in a real-life context from August to October 2015 in 11 public health services in Brazil. Statistical analysis involved obtaining frequencies of the variables of interest and multiple Poisson regression analyses. <h3>Results:</h3> We evaluated 792 patients, of whom 89% were women, with median age of 56.6 years. 78.73% had a positive rheumatoid factor and 55.2% had an erosive disease. The median Disease Activity Score was 3.52, the median CDAI score was 9. Of the patients, 67.9% used 5 or more drugs as follows: mean of 2.8 and maximum of 5 drugs for RA, mean of 2.7 and maximum of 9 different types of medications for comorbidities, and mean of 5.5 and maximum of 11 drugs in total. The most commonly used drugs, besides specific drugs for underlying diseases, were vitamin D (63.8%), folic acid (61.1%), calcium (57%), and antihypertensive drugs (47%). In the multivariate analysis, the use of corticosteroids, methotrexate, and biological DMARDs and number of comorbidities (all with P &lt;0.001) were statistically significant. Age, schooling, rheumatoid factor positivity, and measures of activity by compound disease activity indexes were not associated with polypharmacy. <h3>Conclusion:</h3> The prevalence of polypharmacy was high (67.9%) in this population with RA, much higher than that described for elderly populations and other chronic diseases. This data can serve as an alert for this important and rarely-discussed aspect of RA. <h3>References:</h3> [1] Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics 2017;17:230. [2] da Rocha Castelar-Pinheiro G, Vargas-Santos AB, de Albuquerque CP, Bértolo MB, Júnior PL, Giorgi RDN, et al. The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil. Adv Rheumatol 2018;58:9. [3] Kim J, Parish AL. Polypharmacy and medication management in older adults. Nurs Clin North Am. 2017;52(3):457-468. [4] Abolbashari M, Macaulay TE, Whayne TF, Mukherjee D, Saha S. Polypharmacy in cardiovascular medicine: problems and promises! Cardiovasc Hematol Agents Med Chem. 2017;15(1):31-39. <h3>Disclosure of Interests:</h3> Ana Paula Gomides Grant/research support from: Has received personal support and consulting fees from Pfizer and Janssen, Consultant for: Has received personal support and consulting fees from Pfizer and Janssen, Paid instructor for: Has received personal support and consulting fees from Pfizer and Janssen, Cleandro Albuquerque Shareholder of: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Consultant for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Paid instructor for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Speakers bureau: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Ana Beatriz Vargas-Santos Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Claiton Brenol Shareholder of: Has participated in clinical and/or experimental studies related to this work and sponsored by AbbVie, BMS, Janssen, Pfizer and Roche; has received personal or institutional support from AbbVie, BMS, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer and Roche, Grant/research support from: Has participated in clinical and/or experimental studies related to this work and sponsored by AbbVie, BMS, Janssen, Pfizer and Roche; has received personal or institutional support from AbbVie, BMS, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer and Roche, Consultant for: Has participated in clinical and/or experimental studies related to this work and sponsored by AbbVie, BMS, Janssen, Pfizer and Roche; has received personal or institutional support from AbbVie, BMS, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer and Roche, Paid instructor for: Has participated in clinical and/or experimental studies related to this work and sponsored by AbbVie, BMS, Janssen, Pfizer and Roche; has received personal or institutional support from AbbVie, BMS, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer and Roche, Speakers bureau: Has delivered speeches at events sponsored by AbbVie, Janssen, Pfizer and Roche, Ivanio Pereira Consultant for: Has received consulting fees from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Speakers bureau: Has received speaking fees Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Karina Bonfiglioli Speakers bureau: Has received speaking fees from Roche, Pfizer, Bristol-Myers Squibb, Abbvie and Janssen., Manoel Bertolo Speakers bureau: Has delivered speeches at events sponsored by AbbVie and Pfizer, Maria Raquel Pinto: None declared, Maria de Fátima Sauma: None declared, Paulo Louzada Jr Consultant for: Has received consulting fees from Pfizer, Rina Giorgi Consultant for: Has received consulting fees from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Speakers bureau: Has received speaking fees from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Sebastiao Radominski Consultant for: Abbvie, Celgene, Genentech/Roche, Janssen, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Genentech/Roche, Janssen, Pfizer, UCB, Licia Mota Speakers bureau: Has delivered speeches at events sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Geraldo Castelar: None declared