RESEARCH - Comparing the long term outcome between MTX and SSZ prescribed as first DMARD

[Guest guest]

Ann Rheum Dis. Published Online First: 15 March 2006.

Comparing the long term clinical outcome between methotrexate and

sulfasalazine prescribed as the first DMARD in patients with inflammatory

polyarthritis

Abstract

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

in patients with inflammatory polyarthritis (IP) treated with either

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

drug (DMARD).

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

patients with IP, were eligible for this analysis if they were commenced on

either SSZ (331) or MTX (108) as their first DMARD within 3 months. Outcomes

assessed included the Disease Activity Score (DAS28), HAQ, radiological

erosions (Larsen score) and cumulative mortality together with the

proportions still on the original therapy. 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 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 five years the proportion erosive was lower in

the MTX group: odds ratio 0.3 (0.1-0.8) 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 compared to SSZ.

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

and SSZ, although it would appear that MTX has stronger potential to

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

http://ard.bmjjournals.com/cgi/content/abstract/ard.2005.049775v1

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org