Black Patients With RA Less Likely Than White Counterparts to Be Prescribed a Biologic

New study findings highlight the presence of racial disparities among patients with rheumatoid arthritis (RA), showing that Black patients are less likely to be prescribed a biologic than White patients.

The study, drawing on data from over 1800 patients from 2010 to 2018, also found that Black patients with RA are more likely to be prescribed glucocorticoids, which come with a risk of serious long-term adverse effects.

“With the explosion of effective therapies for rheumatoid arthritis, it is particularly important to make sure that we are treating patients in the best way possible,” said Michael George, MD, MSCE, assistant professor of medicine at the Hospital of the University of Pennsylvania, and co-author of the study, in a statement. “Variability in practice, and disparities in treatment, suggest that there is room for significant improvement.”

According to the study findings, 67% of Black patients were prescribed a biologic—a more effective treatment for controlling RA disease and preventing joint damage—compared with 74% of White patients. Meanwhile, Black patients were significantly more likely to be prescribed prednisone (79.3% vs 69.1%) and conventional disease-modifying antirheumatic drugs (DMARDs; 96.7% vs 93.5%) compared with White patients.

Historically, the impact of racial disparities on access to care and effective treatment options have been poorly understood, although previous research has indicated that non-White patients are less likely to use a biologic than White patients, even when accounting for comparable disease activity and access to treatment.

“This project supports prior work showing reduced use of biologics and a greater use of prednisone in patients who were Black—which could potentially mean worse outcomes or increased steroid side effects in this group,” said George in a statement. “A key next step that many are working on is understanding the key drivers of these disparities—understanding why they exist (eg, access to medications, insurance, patient-provider communication, health beliefs, etc) is important so we know how to address these disparities.”

All patients had at least 2 RA diagnoses and at least 1 prescription of a DMARD during follow-up or from their first to their last clinic visit. Of the patients, 35% were Black, 54% were White, and the median age was 55 years.

Black patients tended to be older, have a higher body mass index, and have cardiovascular disease and diabetes, as well as be former or current smokers. Throughout the 8-year study period, these patients presented significantly more to the emergency department (ED), with a median of 0.24 ED visits per patient per year compared with 0.00 for White patients.

According to the researchers, this could potentially be explained by higher rates of comorbidities as well as differences in geographic location.

Additional studies are needed to examine what drives racial disparities in access to care and the related outcomes.

Reference

He E, Cornblath E, Yalamanchi P, Ogdie E, Baker J, George M. Characterization of racial disparities in rheumatoid arthritis treatment choice and location of care. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0044.