Therapy for rheumatoid arthritis consists of a variety of specific treatments applied sequentially, either alone or in combination. Long- term management may thus be considered to be represented by a series of """"""""therapeutic segments."""""""" This project analyzes the effectiveness, toxicity, and costs of each segment. It develops cost-effectiveness and toxicity-effectiveness ratios for each drug, conditional upon patient characteristics and prior therapy. The project introduces the important new clinical concepts of the """"""""therapeutic segment"""""""" and of effectiveness conditioned upon immediately preceding therapy. The current project will evaluate new drug starts in over 7000 RA patients with many studied from the first year of disease. Effectiveness will be determined by drug effects upon disability levels, pain levels, and patient global assessments, determined by adjusted differences between pre- and post-treatment values over different time periods and at the beginning and end of therapeutic segments and by comparison of observed and expected values based upon linear regression in individual patients. Toxicity will be estimated by the Toxicity Index, with improved weighting techniques to be developed in the Project. Drug costs will be calculated as costs of drugs, costs of monitoring, costs of additional patient visits, and costs of treatment and prophylaxis for toxicity. This project builds upon large, long-term, high quality data sets, and techniques for estimation of effectiveness, toxicity, and costs developed by this team, in order to provide unique and important data to guide therapeutic choices toward improved outcomes for RA patients.

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Stanford University
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Chester Wasko, Mary; Dasgupta, Abhijit; Ilse Sears, Genevieve et al. (2016) Prednisone Use and Risk of Mortality in Patients With Rheumatoid Arthritis: Moderation by Use of Disease-Modifying Antirheumatic Drugs. Arthritis Care Res (Hoboken) 68:706-10
Wasko, Mary Chester M; Dasgupta, Abhijit; Hubert, Helen et al. (2013) Propensity-adjusted association of methotrexate with overall survival in rheumatoid arthritis. Arthritis Rheum 65:334-42
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Chakravarty, Eliza F; Hubert, Helen B; Lingala, Vijaya B et al. (2008) Reduced disability and mortality among aging runners: a 21-year longitudinal study. Arch Intern Med 168:1638-46
Hueber, Wolfgang; Tomooka, Beren H; Zhao, Xiaoyan et al. (2007) Proteomic analysis of secreted proteins in early rheumatoid arthritis: anti-citrulline autoreactivity is associated with up regulation of proinflammatory cytokines. Ann Rheum Dis 66:712-9
Bruce, Bonnie; Fries, James F; Murtagh, Kirsten Naumann (2007) Health status disparities in ethnic minority patients with rheumatoid arthritis: a cross-sectional study. J Rheumatol 34:1475-9
Bruce, Bonnie; Lorig, Kate; Laurent, Diana (2007) Participation in patient self-management programs. Arthritis Rheum 57:851-4
Hueber, Wolfgang; Kidd, Brian A; Tomooka, Beren H et al. (2005) Antigen microarray profiling of autoantibodies in rheumatoid arthritis. Arthritis Rheum 52:2645-55
Bruce, B; Fries, J F (2005) The Arthritis, Rheumatism and Aging Medical Information System (ARAMIS): still young at 30 years. Clin Exp Rheumatol 23:S163-7

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