Glucocorticoid purchases and methotrexate persistence in early rheumatoid arthritis in Finland

OBJECTIVE: This study aimed to explore purchases of methotrexate (MTX), biological disease-modifying anti-rheumatic drugs (bDMARDs), Janus kinase inhibitors (JAKis), and glucocorticoids (GCs) in early rheumatoid arthritis (RA) in Finland. METHOD: The study included 3046 monitored patients with early RA, who obtained reimbursement for RA medication during 2016-2020. The patients were divided into three groups according to the number of GC tablet purchases during 6 months after the reimbursement day: Group 0, no GC purchases; Group 1, purchased < 90 tablets; Group 2, purchased ≥ 90 tablets. Medication purchases were tracked in 6 month periods until the end of 2021. RESULTS: Of the monitored early RA patients, 68% purchased GCs during the initial 6 months and 43% during 6-11 months after the reimbursement date. Over 90% of the patients purchased MTX during the first year in all groups. Patients in Group 2 had the highest baseline disease activity. After the first year, the percentage of bDMARD purchasers (11% vs 6.8%, p = 0.03) and MTX users (79% vs 74%, p = 0.06) was higher in Group 2 than in Group 0. Nevertheless, persistence with analysed anti-rheumatic medications remained similar, with no statistically significant differences, during the whole follow-up period in all groups. CONCLUSION: In early RA, the use of oral GCs is common and continues longer than recommended by the European Alliance of Associations for Rheumatology (EULAR). Persistence with treatment with MTX, bDMARDs, and JAKis in patients who continued medication was not influenced by the initial GC regimen.