Background/Purpose: Several studies initiating disease modifying anti-rheumatic drugs (DMARDs) in DMARD naïve patients have suggested that a significant portion of rheumatoid arthritis (RA) patients will experience and sustain a significant clinical response to methotrexate (MTX) monotherapy (MTX-MON). Little information is available about the long term persistence of MTX-Mon in clinical practice.
Methods: A cross sectional analysis of RA patients in the Veterans Affairs Rheumatoid Arthritis (VARA) registry recorded DMARD history in the VA computerized patient record system (CPRS) and VA pharmacy records. Patients with RA of greater than 3 years duration who were currently receiving MTX-MON were identified and compared to VARA patients who had received MTX but had either discontinued the drug and/or received other DMARDs in addition to MTX.
Results: Of the 1039 RA patient reviewed, 912 (88%) had an RA disease duration >3years. Of these patients 832 (91%) had received MTX and 439 (48%) were continuing to receive MTX. Of the 832 patients treated with MTX-MON, 38 (5%) had continued MTX and not received other DMARDs over the duration of their disease (16 +11 years). An additional 98 (11%) patients had received other DMARDs alone or in combination with MTX in the past, but were currently only receiving MTX-MON at the time of the review. Many patients received MTX in combination with traditional DMARDs, anti-TNF drugs (TNF), or other biologic (OB) agents. A comparison of MTX-MON patients to other patients with >3 years of RA history treated with MTX did not identify any baseline factors associated with MTX-MON persistence, including patient demographics, serologic data for rheumatoid factor and anti-CCP, and shared epitope (SE). Pain score reported on a 10 point range at clinic visits and a cumulative composite measure of DAS28 over time calculated as DAS28 area under the curve (DAS28 AUC) were statistically significantly lower in MTX-MON patients naïve to other DMARDs in comparison to all other groups and all MTX currently on MTX alone in comparison to patient currently on DMARD combinations (p<0.001). A comparison of all patient currently on MTX to all patient currently on MTX in combinations with other DMARDs showed an older age at RA onset (54±14 versus 49±13, p<0.001) and age at evaluation (69±11 versus 64±11, p<0.005), but no other statistically significant differences.
Conclusions: Long term persistence with MTX therapy alone is very uncommon with the majority of patients currently receiving MTX alone having a history of receiving other DMARDs during their past management. There were no baseline disease characteristics associated with long term persistent MTX-MON. While almost half of the patients with RA in our cohort continue to receive MTX, the vast majority of patients will receive additional DMARD therapy and/or discontinue MTX during the course of their disease.
Disclosure: G. W. Cannon, None; B. C. Sauer, None; K. L. Martin, None; C. L. Hayden, None; A. M. Reimold, None; L. Caplan, None; J. S. Richards, None; G. S. Kerr, None; D. S. Johnson, None; T. R. Mikuls, None.