Racial Disparity Seen in Initiation of Newer Diabetes Medications

Treatments for JSpA are based on agents evaluated in adult SpA.[7,11] The 2011 ACR guidelines are for JIA and are not specific to JSpA.[11] The algorithms for peripheral disease consider the number of active joints and prognosis.[11] First-line treatment is essentially a brief trial of NSAID monotherapy. For persistent activity, the ACR suggests adding or switching to a disease-modifying anti-rheumatic drug (DMARD), such as methotrexate, sulfasalazine, or leflunomide. Glucocorticoid intraarticular injections are advised for all children with active arthritis.[11] DMARDs are effective for peripheral JIA but have not been proven effective for axial disease or enthesitis in JSpA.[7] However, open-label studies indicate sulfasalazine improves symptoms in juvenile AS, ERA, and PsA.[7] For JIA refractory to NSAIDs and DMARDs, ACR guidelines recommend a tumor necrosis factor (TNF) inhibitor.[11] The rate and type of treatment escalation depends on disease activity.[7]
Treatments for JSpA are based on agents evaluated in adult SpA.[7,11] The 2011 ACR guidelines are for JIA and are not specific to JSpA.[11] The algorithms for peripheral disease consider the number of active joints and prognosis.[11] First-line treatment is essentially a brief trial of NSAID monotherapy. For persistent activity, the ACR suggests adding or switching to a disease-modifying anti-rheumatic drug (DMARD), such as methotrexate, sulfasalazine, or leflunomide. Glucocorticoid intraarticular injections are advised for all children with active arthritis.[11] DMARDs are effective for peripheral JIA but have not been proven effective for axial disease or enthesitis in JSpA.[7] However, open-label studies indicate sulfasalazine improves symptoms in juvenile AS, ERA, and PsA.[7] For JIA refractory to NSAIDs and DMARDs, ACR guidelines recommend a tumor necrosis factor (TNF) inhibitor.[11] The rate and type of treatment escalation depends on disease activity.[7]
Significantly lower rates of initiation seen in Black and American Indian or Alaskan Native individuals

HealthDay News — Black and American Indian or Alaskan Native individuals have significantly lower rates of initiation of newer diabetes medication, according to a study published in the February issue of The Lancet Regional Health-Americas.

Ahmed Elhussein, from the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues conducted a secondary analysis of data from the Look AHEAD (Action for Health in Diabetes) trial (4,892 participants) to examine the association of race/ethnicity with the initiation of newer diabetes medications (glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase 4 inhibitors, and sodium/glucose cotransporter 2 inhibitors).

The researchers found that over a median follow-up of 8.3 years, 45.2 percent of participants initiated newer diabetes medications. There was an association between race/ethnicity with newer diabetes medication initiation, with lower initiation among Black (hazard ratio, 0.81) and American Indian or Alaskan Native participants (hazard ratio, 0.51), independent of socioeconomic factors. There was also an inverse association seen between yearly family income and initiation of newer diabetes medications (hazard ratio, 0.78) when comparing the lowest and highest income groups. Glucagon-like peptide 1 receptor agonists mostly drove the findings.

“The association between race/ethnicity and initiation of newer diabetes medications persisted after accounting for differences in socioeconomic factors,” the authors write. “These findings warrant attention as disparities in access to newer diabetes medications may exacerbate existing racial/ethnic disparities in diabetes care.”

Abstract/Full Text