Re: Prescribing Patterns for Methotrexate in RA Deemed 'Too Little,Too Late'

[Guest guest]

Do you suppose any rheumatologists will read this or the Journal of

Rheumatology article, a?

Sigh,

[ ] Prescribing Patterns for Methotrexate in RA Deemed

'Too Little,Too Late'

> Prescribing Patterns for Methotrexate in RA Deemed 'Too Little, Too

Late'

>

> By Karla Gale

>

> NEW YORK (Reuters Health) Nov 06 - According to a novel " therapeutic

segment

> approach " used to study response to treatment with methotrexate (MTX)

for

> rheumatoid arthritis (RA), treatment tends to be suboptimal in

clinical

> practice.

>

> Dr. F. Fries, and associates at the Stanford University School

of

> Medicine, defined the MTX therapeutic segment as the " period that

begins

> with start of MTX and terminates when MTX is discontinued or another

disease

> modifying antirheumatic drug is added. " The Palo Alto,

California-based

> researchers maintain that theirs is a " potentially illuminating

approach to

> the analysis of treatment decisions. "

>

> They studied 437 patients drawn from eight Arthritis, Rheumatism, and

Aging

> Medical Information System (ARAMIS) data centers who initiated MTX

treatment

> between 1988 and 1996. The Disability Index of the Health Assessment

> Questionnaire was prospectively determined every 6 months.

>

> Overall, Dr. Fries' group found a pattern of MTX treatment for RA that

was

> " too little, too late, and too long to treatment change. "

>

> Average patient disability improved and then leveled off at about 30

to 42

> months, after which disability began to increase again. Disability

index

> scores averaged 1.48 (on a scale of 0 to 3) at baseline, with a nadir

of

> 1.23 at about 30 months. The mean score was 1.39 at 84 months. Eight

or more

> years elapsed before disability returned to baseline levels.

>

> This protracted response, according to the research team's report in

the

> Journal of Rheumatology for October, " suggests that dosage titration

of MTX

> may have been slower than desirable and that some therapeutic benefit

may

> thereby have been lost. "

>

> " I think this situation is still true today, " Dr. Fries told Reuters

Health.

> " On one hand, academic researchers recommend that MTX be prescribed at

15 or

> 17.5 or as much as 22.5 mg/week. In practice it's more like 10

mg/week. "

>

> " We have all been concerned with liver fibrosis, but that's not really

much

> of a problem; it's a process that takes years, " the researcher added.

" So

> physicians should titrate the dose to a predetermined maximum within 6

> months based on a patient's size and other medications or to

toxicity. "

>

> " When MTX is used aggressively, we get results that are not so

different "

> from those achieved with the newest therapeutic agents for RA, Dr.

Fries

> continued, " and the cost is only a fraction. "

>

> In an accompanying editorial, Dr. H. Giannini, of the

University of

> Cincinnati College of Medicine in Ohio, writes that the therapeutic

segment

> approach " should be considered a major addition to the methodological

tools

> available to the field of evidence-based medical and clinical

effectiveness

> research. "

>

> He maintains that the conclusions and recommendations by Dr. Fries'

team are

> valid.

>

> J Rheumatol 2002;29:2084-2091.

[Guest guest]

I hope so , but I wonder how they keep up with all the articles that are

written.

a

> Do you suppose any rheumatologists will read this or the Journal of

> Rheumatology article, a?

>

> Sigh,

>

>

>

>

> [ ] Prescribing Patterns for Methotrexate in RA Deemed

> 'Too Little,Too Late'

>

>

>> > Prescribing Patterns for Methotrexate in RA Deemed 'Too Little, Too

> Late'

>> >

>> > By Karla Gale

>> >

>> > NEW YORK (Reuters Health) Nov 06 - According to a novel " therapeutic

> segment

>> > approach " used to study response to treatment with methotrexate (MTX)

> for

>> > rheumatoid arthritis (RA), treatment tends to be suboptimal in

> clinical

>> > practice.

>> >

>> > Dr. F. Fries, and associates at the Stanford University School

> of

>> > Medicine, defined the MTX therapeutic segment as the " period that

> begins

>> > with start of MTX and terminates when MTX is discontinued or another

> disease

>> > modifying antirheumatic drug is added. " The Palo Alto,

> California-based

>> > researchers maintain that theirs is a " potentially illuminating

> approach to

>> > the analysis of treatment decisions. "

>> >

>> > They studied 437 patients drawn from eight Arthritis, Rheumatism, and

> Aging

>> > Medical Information System (ARAMIS) data centers who initiated MTX

> treatment

>> > between 1988 and 1996. The Disability Index of the Health Assessment

>> > Questionnaire was prospectively determined every 6 months.

>> >

>> > Overall, Dr. Fries' group found a pattern of MTX treatment for RA that

> was

>> > " too little, too late, and too long to treatment change. "

>> >

>> > Average patient disability improved and then leveled off at about 30

> to 42

>> > months, after which disability began to increase again. Disability

> index

>> > scores averaged 1.48 (on a scale of 0 to 3) at baseline, with a nadir

> of

>> > 1.23 at about 30 months. The mean score was 1.39 at 84 months. Eight

> or more

>> > years elapsed before disability returned to baseline levels.

>> >

>> > This protracted response, according to the research team's report in

> the

>> > Journal of Rheumatology for October, " suggests that dosage titration

> of MTX

>> > may have been slower than desirable and that some therapeutic benefit

> may

>> > thereby have been lost. "

>> >

>> > " I think this situation is still true today, " Dr. Fries told Reuters

> Health.

>> > " On one hand, academic researchers recommend that MTX be prescribed at

> 15 or

>> > 17.5 or as much as 22.5 mg/week. In practice it's more like 10

> mg/week. "

>> >

>> > " We have all been concerned with liver fibrosis, but that's not really

> much

>> > of a problem; it's a process that takes years, " the researcher added.

> " So

>> > physicians should titrate the dose to a predetermined maximum within 6

>> > months based on a patient's size and other medications or to

> toxicity. "

>> >

>> > " When MTX is used aggressively, we get results that are not so

> different "

>> > from those achieved with the newest therapeutic agents for RA, Dr.

> Fries

>> > continued, " and the cost is only a fraction. "

>> >

>> > In an accompanying editorial, Dr. H. Giannini, of the

> University of

>> > Cincinnati College of Medicine in Ohio, writes that the therapeutic

> segment

>> > approach " should be considered a major addition to the methodological

> tools

>> > available to the field of evidence-based medical and clinical

> effectiveness

>> > research. "

>> >

>> > He maintains that the conclusions and recommendations by Dr. Fries'

> team are

>> > valid.

>> >

>> > J Rheumatol 2002;29:2084-2091.

>

>