Attending Rheumatologist Appears To Impact Methotrexate Survival In Rheumatoid Arthritis Patients

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Attending Rheumatologist Appears To Impact Methotrexate Survival In

Rheumatoid Arthritis Patients

A DGReview of : " Longterm observational study of methotrexate use in a dutch

cohort of 1022 patients with rheumatoid arthritis "

Journal of Rheumatology

01/07/2004

By Jill

Folic acid supplementation, concurrent use of prednisolone, as well as the

individual attending rheumatologist may all influence methotrexate (MTX)

survival in rheumatoid arthritis (RA) patients, according to Dutch

researchers.

Previous studies have identified several factors relating to MTX survival,

including age, disease duration, race, co-medication, and attending

rheumatologist. However, the majority of studies consider patients treated

before 1996, and changes in MTX treatment have since taken place.

To define which factors determined MTX survival in the past 9 years,

Hoekstra, MD, and colleagues of Medisch Spectrum Twente-Enschede, the

Netherlands performed a retrospective study of data associated with 1,022 RA

patients who received MTX treatment.

Patients were identified via a computer based diagnosis registration system,

and 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.

Analysis included 1,072 MTX treatment episodes. The cumulative MTX survival

probability after 5 years was 64%, and after 9 years was 50%.

Univariate analysis revealed a significant association between MTX survival

and folic acid supplementation (P < .001), attending rheumatologist (P =

..02), concurrent prednisolone treatment (P = .01), concurrent sulfasalazine

treatment (P = .002), and the number of previously used disease modifying

drugs (DMARDs)(P = .05).

In the multivariate analysis, MTX survival was significantly associated with

folic acid supplementation (P = .001), attending rheumatologist (P = .002),

and concurrent prednisolone treatment (P = .005).

Interestingly, both toxicity and inefficacy as reasons for MTX treatment

withdrawal were found significantly related to the factor of attending

rheumatologist. Moreover, the attending rheumatologist was also

significantly related to patient mean age, folic acid supplementation,

number of previous DMARDs, starting dose, and maximum dose.

" None of the above mentioned variables is solely responsible for the

difference in MTX survival between rheumatologists, " the investigators said.

" Therefore other factors, such as physician confidence in efficacy and

safety of MTX, might be responsible. "

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