Longterm observational study of methotrexate use in a dutch cohort of 1022 patients with rheumatoid arthritis

[Guest guest]

J Rheumatol. 2003 Nov;30(11):2325-9.

Longterm observational study of methotrexate use in a Dutch cohort of

1022 patients with rheumatoid arthritis.

Hoekstra M, van de Laar MA, Bernelot Moens HJ, Kruijsen MW, Haagsma CJ.

Department of Rheumatology, Medisch Spectrum Twente-Enschede, PO Box

5000, 7500 KA Enschede, The Netherlands. m.hoekstra@...

OBJECTIVE: To study which factors are associated with longterm

methotrexate (MTX) use in rheumatoid arthritis (RA). METHODS: All patients

with RA who had started MTX after January 1, 1993, were selected from a

regional hospital based registration system. Data on demographic and

clinical features were retrieved through chart review. By means of life

table analysis and regression analysis, MTX survival and the relation

between demographic variables, clinical features, and MTX survival were

studied. RESULTS: A total of 1072 MTX treatment episodes in 1022 patients

were analyzed. The cumulative MTX survival probability after 5 years was

64%, and after 9 years was 50%. Univariate analysis showed a significant

relation between MTX survival probability and folic acid supplementation,

attending rheumatologist, concurrent prednisolone use, concurrent

sulfasalazine use, and the number of previous disease modifying drugs. In

the multivariate analysis folic acid supplementation, attending

rheumatologist, and concurrent prednisolone use remained significantly

related to MTX survival. Age, disease duration, and creatinine clearance

were not. CONCLUSION: In this retrospective study of 1022 patients with RA

the cumulative MTX survival probability was 64% after 5 years and 50% after

9 years. Folic acid supplementation and to a lesser extent prednisolone were

associated with a longer MTX survival. In addition, treatment strategies of

individual rheumatologists influenced MTX survival.

PMID: 14677172