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Anti-TNF-treated patients with RA may taper, discontinue methotrexate
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Many patients with rheumatoid arthritis who received tumor necrosis factor-alpha inhibitors were able to successfully taper down from or discontinue methotrexate, according to recently published research.
Researchers studied data from the Dutch Rheumatoid Arthritis Monitoring (DREAM) register, which includes all patients who received a biological treatment since February 2003 in the Netherlands. Patients had a rheumatoid arthritis (RA) Disease Activity Score in 28 joints (DAS28) of 3.2 or greater and had prior treatment with at least two disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate. Patients were assessed when treatment with tumor necrosis factor-alpha (TNF) inhibitors was initiated and received follow-up every 3 months.
A total of 1,933 patients with RA received a TNF-alpha inhibitor between February 2003 and June 2012, and 69% (n = 1,331) received concomitant methotrexate. Dose tapering occurred in 34.4% of patients within 6 months of TNF-alpha inhibitor initiation (median 149 days). After the initial 6 months, 41.3% of the patients continued further tapering while 12.2% increased the dose. The DAS28 increased by more than 0.6 in 21% of the patients, and patients who relapsed were more likely to receive less than 10 mg of methotrexate after tapering compared to patients who did not relapse. Patients who relapsed had a lower DAS28, started tapering later, had a history of more DMARDs and received a lower dose prior to tapering.
Methotrexate was discontinued by 9.5% of patients, half of whom discontinued by 9 months. Patients had an average DAS28 of 3.6 at discontinuation, and 30.6% received doses greater than 15 mg before discontinuation. At 6 months, 21% of patients relapsed and at 12 months, 24% relapsed. No significant differences were seen between patients who relapsed and patients who did not. Following discontinuation or methotrexate, the risk for discontinuing the TNF-alpha inhibitor decreased by 25.6%. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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