Early use of subcutaneous methotrexate may delay need for biologic DMARDs

LONDON — Patients with moderate to severe rheumatoid arthritis who receive early treatment with subcutaneous methotrexate monotherapy may have reduced use of biologic disease-modifying antirheumatic drugs compared to patients treated with oral methotrexate monotherapy, according to data from the Canadian Early Arthritis Cohort study presented here.

“In this large, Canadian cohort of early rheumatoid arthritis (RA) patients with moderate to high disease activity who were started on methotrexate, we found the use of subcutaneous methotrexate monotherapy was associated with a delayed start of biologics,” Stephanie K. Gottheil, MD, said at the EULAR Annual Congress.

The Canadian Early Arthritis Cohort (CATCH) is a multicenter, national prospective cohort study of patients with early RA. In the study, Gottheil and colleagues included patients who met 1987 or 2010 ACR criteria for RA, had 12 months or less of symptom duration, had moderate or high disease activity based on DAS28 at baseline and were treated with methotrexate. Researchers excluded patients treated with a biologic at baseline.

Gottheil and colleagues followed 1,189 patients until they started a biologic, were lost to follow-up or followed them until the end of the 36-month study. Researchers used Cox proportional hazards survival analysis to estimate effects of oral methotrexate monotherapy, subcutaneous methotrexate monotherapy and methotrexate combination therapy after adjusting for age, gender, education level, symptom duration, comorbidities, seropositivity, baseline erosions, baseline DAS28 and corticosteroid use. Overall, 71.3% of patients were female with mean age of 54.4 years. The mean symptom duration was 5.5 months and the DAS28 was 5.5. Oral methotrexate monotherapy was used as initial treatment in 19% of patients; subcutaneous methotrexate monotherapy was used in 19%; and methotrexate combination therapy was used in 62% of patients.

For biologic-free survival, 17.5% of patients who received methotrexate monotherapy were started on a biologic within 36 months. This was compared to 23.6% of patients who received methotrexate combination therapy and later started on a biologic. Gottheil said this was a significant difference.

Researchers found patients treated with subcutaneous methotrexate monotherapy were half as likely to require biologics as patients who were treated with oral methotrexate monotherapy. There was no significant difference between methotrexate combination therapy and oral methotrexate monotherapy for this outcome. – by Kristine Houck, MA, ELS

Disclosure: Gottheil reports she receives grant and research support from Amgen Canada, Pfizer Canada., Hoffmann-La Roche, UCB Canada, Bristol-Myers Squibb Canada, AbbVie, Janssen, Medexus and Eli Lilly Canada.

Reference:

Gottheil S, et al. Abstract # OP0179. Presented at: EULAR Annual Congress; June 8-11, 2016; London.