Methotrexate therapy reduces mortality in patients with rheumatoid arthritis

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Methotrexate therapy reduces mortality in patients with rheumatoid

arthritis

Apr 5, 2002 Methotrexate therapy is associated with a reduction

in mortality in patients with rheumatoid arthritis, according to the

results of a prospective cohort study published in the Lancet.

Researchers at the Harvard School of Public Health, Boston,

and other institutions followed 1,240 patients with rheumatoid arthritis

for a mean 6 years and evaluated the association between use of various

disease-modifying antirheumatic drugs and mortality.

The overall mortality rate was 15%, and 47% of patients were

treated with methotrexate.

Risk factors for mortality were more prevalent in patients

who were treated with methotrexate. Nonetheless, after adjustment for

this potential confounder, methotrexate therapy was associated with a

60% reduction in mortality when compared with no therapy. In contrast,

there was no significant reduction in mortality associated with

sulfasalazine, penicillamine, hydroxychloroquine, or intramuscular gold

therapy.

When the data were analyzed with respect to cause of death,

methotrexate therapy was associated with a 70% reduction in

cardiovascular mortality and a 40% reduction in noncardiovascular

mortality.

These findings suggest that methotrexate reduces mortality

in patients with rheumatoid arthritis, whereas other conventional

disease-modifying antirheumatic drugs do not have this benefit. The

authors conclude, " Our data indicate that methotrexate may provide a

substantial survival benefit, largely by reducing cardiovascular

mortality. The gain in life expectancy could be considered in selecting

a cost-effective, disease-modifying antirheumatic drug on a long-term

basis. Additionally, the survival benefit of methotrexate would set a

standard against which new disease-modifying antirheumatic drugs should

be compared. "

References:

Choi HK, Hemán MA, Seeger JD, et al.: Methotrexate and mortality

in patients with rheumatoid arthritis: a prospective study. Lancet. Apr

6 2002; 359:1173-77.

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org