Treatment Strategies in Early Rheumatoid Arthritis Methotrexate Management: Results From a Prospective Cohort Academic Article uri icon

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abstract

  • OBJECTIVE: To assess real-world practice patterns surrounding treatment initiation and adjustments over time for methotrexate (MTX) and non-MTX-based treatment strategies in early rheumatoid arthritis (RA). METHODS: We studied a multicenter, incident early RA cohort (enrolled 2007-2017 within 1 year of symptoms) who fulfilled American College of Rheumatology/European League Against Rheumatism criteria. Adult patients with RA were eligible if treatment with MTX (± other disease-modifying antirheumatic drugs [DMARDs]) was initiated within 90 days of cohort entry. We compared time until treatment change for 4 initial MTX-based therapies and time to second treatment change after the first change. The definition of treatment change included changing of route for MTX monotherapy, adding or stopping a DMARD or biologic, and changing dose/frequency of a DMARD or biologic. RESULTS: There was great variability of treatment at initiation and during therapy adjustment. In 1,484 patients with early RA, the majority initiated MTX monotherapy (oral or subcutaneous [SC]). Patients receiving SC MTX monotherapy changed treatment less (45% versus 79%) and remained on treatment longer (hazard ratio [HR] 0.52 [95% confidence interval (95% CI) 0.4-0.67]) than those receiving oral MTX monotherapy. Most therapy adjustments involved adding a DMARD or changing to a non-MTX DMARD. Those adults taking biologics and who were receiving triple therapy had a longer time without treatment change (HR 0.26 [95% CI 0.16-0.42] and HR 0.57 [95% CI 0.38-0.85], respectively). CONCLUSION: We found large variability in the way MTX-based therapies are prescribed in clinical practice. Our findings support the use of SC MTX monotherapy or MTX combination as initial therapy. For subsequent treatment after initial MTX-based therapy, those patients initiating either biologics or triple therapy had a longer time to treatment change than oral MTX monotherapy.

authors

  • Moura, Cristiano S
  • Schieir, Orit
  • Valois, Marie‐France
  • Thorne, Carter
  • Bartlett, Susan J
  • Pope, Janet E
  • Hitchon, Carol A
  • Boire, Gilles
  • Haraoui, Boulos
  • Hazlewood, Glen S
  • Keystone, Edward C
  • Tin, Diane
  • Bykerk, Vivian P
  • Bernatsky, Sasha
  • Baron, Murray
  • Bessette, Louis
  • Colmegna, Ines
  • Fallavollita, Sabrina
  • Haaland, Derek Allan
  • Haraoui, Paul
  • Jamal, Shahin
  • Jamal, Shahin
  • Joshi, Raman
  • Nair, Bindu
  • Panopoulos, Peter
  • Penney, Christopher
  • Rubin, Laurence
  • Villeneuve, Edith
  • Zummer, Michel

publication date

  • August 2020