류마티스 관절염 처방약물 분석 및 약물치료관리 서비스 모델 개발 연구

Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory disease which induces chronic inflammation of the joints and various organs such as kidneys and heart. The important strategy for the treatment of RA is early diagnosis and treatment with appropriate RA mediations such as disease-modifying anti-rheumatic drugs (DMARDs), steroids, and non-steroidal anti-inflammatory drugs (NSAIDs). It is also necessary to persistently take care of RA patients with a proper and effective medication therapy management (MTM) service model because RA is one of chronic diseases as well as needs polypharmacy for optimizing the treatment. The aims of this study were to analyze the prescription patterns of medications for RA and to properly develop its MTM service model. The study was retrospectively conducted through the prescriptions of RA patients who visited a community pharmacy located near the secondary hospital sepcialized in RA between January and February 2015. Of a total of 4380 patients during the study period, 931 were diagnosed with RA. RA male and female patients were 213 (22.88%) and 718 (77.12%), respectively. Methotrexate (MTX) was prescribed to more than 75% of RA patients, followed by hydroxychloroquine (HCQ) and leflunomide (LEF). MTX+HCQ, MTX+LEF, and MTX+tacrolimus (TAC) as a combination therapy were prescribed to 194, 166, and 85 RA patients, respectively. The frequently prescribed steroids included deflazacort (n=358, 38.45%) and prednisolone (n=331, 35.55%). Three hundred seven (32.98%) RA patients received celecoxib. In RA patients using polypharmacy, drug-drug interactions (DDIs) are important issues. MTX and TAC had DDIs with NSAIDs and proton pump inhibitors (PPIs) that were frequently found in RA patients’ prescriptions based on the findings from the anlaysis of RA drug prescription patterns. Over-the-counter (OTC) analgesics such as NSAIDs are abused because pain from RA is not well-controlled, which may lead to acute kidney injury (AKI) as well as gastric ulcer or bleeding. Health supplements like omega-3 fatty acid, vitamin D, antioxidants, and probiotics are also used in RA patients due to their anti-infalmmatory effects. Therefore, it is necessary to develop the RA MTM service model reflecting DDIs, OTC analgesics, and health supplements as well as RA medications including DMARDs, steroids, and NSAIDs. Further studies should be conducted to develop more comprehensive and improved RA MTM service model reflecting biologic agents administered in the hospital, such as etanercept, infliximab, and adalimumab, in order to appropriately control pain, DDIs, and underlying diseases. Moreover, the pilot study of pharmacoeconomic evaluation should be implemented after the RA MTM service model is conducted in clinical settings.