RESEARCH - Comparing the long-term outcome of MTX with sulfasalazine as the first DMARD in inflammatory polyarthritis

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ls of the Rheumatic Diseases 2006;65:1449-1455

© 2006 by BMJ Publishing Group Ltd & European League Against Rheumatism

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EXTENDED REPORT

Comparing the long-term clinical outcome of treatment with methotrexate or

sulfasalazine prescribed as the first disease-modifying antirheumatic drug

in patients with inflammatory polyarthritis

S L Hider1, A Silman1, D Bunn2, S Manning1, D Symmons1 and M Lunt1

1 Arc Epidemiology Unit, Manchester University, Manchester, UK

2 Norfolk Arthritis Register, Norfolk and Norwich University Hospital,

Norwich, UK

Objective: To compare the clinical and functional outcome at 2 and 5 years

in patients with inflammatory polyarthritis treated with either methotrexate

(MTX) or sulfasalazine (SSZ) as the first disease-modifying antirheumatic

drug (DMARD).

Methods: Patients recruited to a primary-care-based inception cohort of

patients with inflammatory polyarthritis were eligible for this analysis if

they were started on either SSZ (n = 331) or MTX (n = 108) as their first

DMARD within 3 months. Outcomes assessed included the Disease Activity Score

(DAS)28, Health Assessment Questionnaire, radiological erosions (Larsen

Score) and cumulative mortality with the proportions still on the original

treatment. To overcome potential bias in allocation to these two treatments,

a propensity score was calculated based on baseline disease status

variables. Results are expressed as the mean difference between MTX and SSZ,

both unadjusted and adjusted for propensity score.

Results: The baseline differences between the two groups disappeared after

adjusting for propensity score. At 2 and 5 years there were few differences

in the clinical outcomes, either unadjusted or after adjustment for

propensity. By contrast, at 5 years the proportion that was erosive was

lower in the MTX group: odds ratio 0.3 (95% confidence interval 0.1 to 0.8),

with a 31% lower Larsen Score after adjustment. At both time points, those

treated with MTX were at least twice as likely to remain on that drug as

those treated with SSZ.

Conclusion: Long-term clinical outcome is similar in patients prescribed MTX

and SSZ, although it would seem that MTX has greater potential to suppress

erosions, which supports it being the first DMARD of choice.

http://ard.bmjjournals.com/cgi/content/abstract/65/11/1449?etoc

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