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Mortality reduced in RA patients who maintained methotrexate therapy
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Patients with rheumatoid arthritis who continued therapy with methotrexate had lower mortality rates when measured 18 years after initiating treatment, according to recent study results.
Researchers in Germany analyzed data on 271 patients with rheumatoid arthritis (RA; disease duration, 8.5 years) who had started methotrexate (MTX) treatment between 1980 and 1987. Modified American College of Rheumatology 20 (ACR20) response was used to measure response to MTX treatment 1 year after baseline. Follow-up data were available for 250 patients (mean age, 57.5 years; 78.4% women) up to 18 years.
Of those patients, 66% had a ≥20% response rate at 1 year (responders), 20% were considered nonresponders, and 14% had stopped MTX treatment because of lack of efficacy or adverse events including nausea, vomiting or stomatitis. Sixty-one percent of patients maintained MTX treatment at 10 years after baseline.
Responders had a 1.6 mortality ratio compared with a 3.2 ratio among nonresponders after 18 years.
“However, when adjusting for age, gender, response to MTX treatment 1 year after baseline, number of swollen joints and comorbidities after 10 years, an independent association of continued MTX treatment with lower mortality was found for the period 10 to 18 years after baseline (HR=0.63; 95% CI, 0.43-0.92),” the researchers reported.
“The results of this study are consistent with the assumption that continued MTX use in patients with severe RA is associated with a decline in mortality rates,” the researchers concluded. “This effect seems to be partly independent of the clinical MTX response. This finding may have an impact on treatment decisions concerning RA patients with a minor response to MTX treatment, favoring add-on therapy over switching to other [disease-modifying antirheumatic drugs].”
Disclosure: The researchers report no relevant financial disclosures.
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