RESEARCH - MTX in RA is frequently effective, even if re-employed after a previous failure

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Research article

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Methotrexate in rheumatoid arthritis is frequently effective, even if

re-employed after a previous failure

Arthritis Research & Therapy 2006, 8:R46 doi:10.1186/ar1902

Abstract

Effectiveness of therapy with individual disease-modifying

antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is limited, and

the number of available DMARDs is finite. Therefore, at some stage during

the lengthy course of RA, institution of traditional DMARDs that have

previously been applied may have to be reconsidered. In the present study we

investigated the effectiveness of re-employed methotrexate in patients with

a history of previous methotrexate failure (original course). A total of

1,490 RA patients (80% female, 59% rheumatoid factor positive) were followed

from their first presentation, yielding a total of 6,470 patient-years of

observation. We identified patients in whom methotrexate was re-employed

after at least one intermittent course of a different DMARD. We compared

reasons for discontinuation, improvement in acute phase reactants, and

cumulative retention rates of methotrexate therapy between the original

course of methotrexate and its re-employment. Similar analyses were

performed

for other DMARDs. Methotrexate was re-employed in 86 patients. Compared with

the original courses, re-employment was associated with a reduced risk for

treatment termination because of ineffectiveness (P = 0.02, by McNemar

test), especially if the maximum methotrexate dose of the original course

had been low (<12.5 mg/week; P = 0.02, by logistic regression). In a

regression model, re-employed MTX was associated with a significantly

reduced hazard of treatment termination compared with the original course of

methotrexate, adjusting for dose and year of employment (hazard ratio 0.64,

95% confidence interval 0.42-0.97; P = 0.04). These findings were not

recapitulated in analyses of re-employment of other DMARDs. Re-employment of

MTX despite prior inefficacy, but not re-employment of other DMARDs, is an

effective therapeutic option, especially in those patients in whom the

methotrexate dose of the original course was low.

Full article:

http://arthritis-research.com/content/8/2/R46

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org