RESEARCH - Benefits of intensive MTX treatment outweigh adverse events in early RA

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Benefits of Intensive Methotrexate Treatment Outweigh Adverse Events

in Early Rheumatoid Arthritis

Laurie Barclay, MD

July 22, 2009 — Intensive treatment with methotrexate may be helpful

in early rheumatoid arthritis despite greater adverse events vs

conventional treatment, according to the results of a study reported

online in the July 5 issue of the ls of the Rheumatic Diseases.

" In the two year Computer Assisted Management in Early Rheumatoid

Arthritis (CAMERA) study, more patients in the intensive MTX

[methotrexate] strategy group (I-group) compared to the conventional

MTX strategy group (C-group) achieved at least one period of remission

during follow-up, " write S.M.M. Verstappen, PhD, from University

Medical Center in Utrecht, the Netherlands, and colleagues from the

Utrecht Rheumatoid Arthritis Cohort study group.

" However, to compare the value of the two strategies, both beneficial

effects and adverse effects are important to weigh. The aim of the

present study was to compare toxicity profiles between both MTX

treatment strategies and to study possible associations between

baseline characteristics with MTX withdrawal and liver toxicity during

follow-up. "

The investigators used logistic regression analyses to identify

possible associations between baseline factors and study withdrawal

because of methotrexate-related adverse events or liver toxicity at

follow-up.

Patients in the conventional treatment group attended outpatient

clinic once every 3 months vs once per 4 weeks in the intensive

treatment group. Both groups were permitted an increase in

methotrexate dose to 30 mg/week when the patient had not responded,

and after subcutaneous administration of methotrexate, cyclosporin was

added to the methotrexate therapy.

All recorded adverse events were relatively mild and often reversible,

but significantly more patients in the intensive treatment group vs

those in the conventional treatment group went on to have

methotrexate-related adverse events.

Multiple regression analyses showed that higher body mass index (BMI)

was significantly associated with study withdrawal for

methotrexate-related adverse events. There was also a trend towards

decreased creatinine clearance being associated with methotrexate

withdrawal. Liver toxicity during follow-up was predicted by higher

serum liver enzyme levels at baseline.

Limitations of this study include missing baseline data in 42% of patients.

" Although the occurrence of adverse events in the intensive treatment

group was higher than in the conventional treatment group, the

previously observed clinical efficacy of an intensive treatment

strategy seems to outweigh the observed toxicity profiles, " the study

authors write. " When starting MTX, attention should be given to

patients with a high BMI and those with increased levels of liver

enzymes and decreased renal function. "

Ann Rheum Dis. Published online July 5, 2009.

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http://www.medscape.com/viewarticle/706294

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