Study Shows Methotrexate Improves Life Expectancy in RA Patients

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Study Shows Methotrexate Improves Life Expectancy in RA Patients

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Paper: Response to Methotrexate Treatment Is Associated with Reduced

Mortality

in Patients with Severe Rheumatoid Arthritis

Authors: Krause, D, et al

Ref: Arthritis & Rheumatism 2000;43:14-21.

Type: Clinical study

Summary: Patients with rheumatoid arthritis (RA) have been shown to have

shorter a life expectancy than the general population. Methotrexate (MTX)

has

been the most commonly used disease-modifying antirheumatic drug (DMARD) for

RA

since the 1950s. MTX has been shown to improve RA symptoms, but its effect

on

long-term outcome, including mortality, has not been studied extensively.

This

study explored the influence of MTX treatment on mortality in patients with

severe RA in Germany.

A group of 271 patients with severe RA who were refractory to other DMARDs

and started MTX treatment between 1980 and 1987 were studied. Patients were

divided into four groups based on their response to MTX treatment after 1

year:

Group 1 included 99 patients who had more than a 50% improvement, group 2

included 70 who experienced a 20-50% improvement, group 3 included 52 who

showed no improvement, and group 4 included 35 who discontinued treatment.

After a mean follow-up of 10 years, mortality was compared to that expected

based on the general population of Germany.

In 1995/1996, outcomes for 256 patients could be documented; 88 (34.4%)

patients had died. Mortality increased with decreasing level of improvement.

The standard mortality ratio in those in group 1 was 1.47, while the ratios

for

groups 2, 3, and 4 were 1.85, 4.11, and 5.56, respectively. The main cause

of

death was cardiovascular disease. The differences between groups were not

explained by baseline differences in measures of disease severity.

" Patients with severe RA who do not response to MTX treatment have a poor

prognosis, with a more than 4-fold increased mortality compared to the

general

population, " wrote the authors, " while RA patients who respond to MTX

treatment

have only a moderately increased mortality rate..This supports the idea that

while persistent high disease activity leads to premature death, the

reduction

of disease activity by MTX treatment improves prognosis. "