RESEARCH - MTX: long-term safety and efficacy in an Australian consultant rheumatology practice

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Intern Med J. 2009 Apr;39(4):228-36.

Methotrexate: long-term safety and efficacy in an Australian

consultant rheumatology practice.

Varatharajan N, Lim IG, Anandacoomarasamy A, Russo R, Byth K, Spencer

DG, Manolios N, Howe GB.

Western Sydney Clinical School, University of Sydney, Sydney, NSW, Australia.

BACKGROUND: The aim of this study was to evaluate the rate and cause

of methotrexate (MTX) termination in clinical practice, describe the

types of toxicities noted, assess the incidence of achieving remission

in rheumatoid arthritis (RA) patients and review the appropriateness

of current clinical guidelines for monitoring MTX treatment.

METHODS: A retrospective, case review of patients seen in a private

rheumatology practice attached to a major Sydney Teaching Hospital was

undertaken over an 18-year period. The primary outcome was time to

cessation of MTX.

RESULTS: Seven hundred and ninety patients satisfied the inclusion

criteria. MTX was terminated in 272 patients (34.4%). Toxicity-related

discontinuation occurred in 93 patients (11.8%) and due to non-adverse

reactions in 179 patients. The median duration of therapy in these two

groups was 2.0 and 2.9 years, respectively. There was no difference in

the average maximum weekly dose of MTX. Of patients with RA, 47.5%

were in remission at last follow up. proportional hazards analyses

showed that those of the female sex remained on treatment

significantly longer than the male sex (hazard ratio (HR) 0.73, 95%

confidence interval (CI) 0.57-0.96; P = 0.014); patients with RA

remained on treatment significantly longer than patients with

seronegative arthritis (HR 0.56, 95%CI 0.42-0.74; P < 0.001). Being of

the male sex aged more than 60 years and having a non-RA diagnosis

predisposed to stopping MTX earlier.

CONCLUSION: MTX is a safe and effective medication. Notable remission

rates are achievable in patients with RA with current conventional

treatment protocols. MTX has a low toxicity profile and this study

stresses the need to re-evaluate and revise the current monitoring

guidelines.

PMID: 19402861

http://www.ncbi.nlm.nih.gov/pubmed/19402861

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