RESEARCH - Efficacy of every-other-week MTX in maintaining remission in RA

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ACR/ARHP 2008 Scientific Meeting

Session: RA Treatment: Small Molecules and Cell-Directed Biological Therapy

Sunday, Oct 26, 2008, 9:00 AM - 6:00 PM

Presentation: 383 - Efficacy Of Every-other-week Methotrexate

Schedule In Maintaining The Remission Of Patients With Rheumatoid

Arthritis

Author(s): Narvaez, Elena Sirvent, Delia Reina, Joan Miquel

Nolla. Department of Rheumatology, Hospital Universitari de Bellvitge,

Barcelona, Spain

Abstract: Background: Methotrexate (MTX) is the DMARD of first choice

of most practitioners for patients with severe rheumatoid arthritis

(RA). If therapy with MTX is effective and the patients achieve a

prolonged remission, a decrease in the dose or in the frequency of

dosing to every-other-week (EOW) is recommended, because therapy is

not innocuous, and some forms of toxicity may arise from accumulated

doses. Discontinuation of MTX does not appear to be a practical

alternative, since it usually results in the relapse of RA some weeks

later. Tapering of the dosage, on the other hand, could become a

feasible alternative for this particular subset of patients, but such

schedules have not been defined for MTX tapering. EOW treatment with

MTX is promising because, in theory, certain side effects may be

decreased while maintaining efficacy. However, the experience with

this regimen has provided inconsistent results.

Objective: To determine if RA patients in remission with weekly MTX

therapy could be switched to an EOW regimen.

Methods: Fifteen patients with RA (all fulfilling the ACR criteria)

who were in clinical remission (defined as DAS28 ˜ 2.6) with weekly

MTX for at least 6 months, were switched to an EOW regimen without a

change in dose. All patients were selected from the outpatients

attending the early arthritis clinic of the Department of Rheumatology

at the Hospital Universitario de Bellvitge (Barcelona, Spain).

Patients were followed up during 1 year being evaluated by the same

doctor at baseline and every 3 months thereafter. The evaluations

included DAS28, HAQ disability index, patient's global health

assessments, acute phase reactants (ESR and CRP) and incidence of

adverse effects.

Results: In all patients the duration of RA was < 4 years and they had

been started on weekly MTX treatment early after diagnosis. Fourteen

of the 15 patients completed the 12 month trial without experiencing a

disease flares. In this group, no significant differences in clinical

or laboratory parameters occurred. There was no change in the use of

analgesics or NSAID and the patients remained in remission.

Only 1 patient relapsed at 2 months after changing the MTX shedule.

This patient was switched back to weekly MTX, and after a few weeks,

her RA was again controlled. None of the patients suffered adverse

effects.

Conclusion: EOW MTX seems to be a valid therapeutic alternative for

maintaining remission in a specific subgroup of RA patients (patients

with a short disease duration who were treated early after disease

onset with weekly MTX and who achieve a sustained remission).

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