Methotrexate (MTX) is recommended the first DMARD in rheumatoid arthritis (RA). Despite its widespread use and more than two decades of experience, considerable variations exist among rheumatologists in prescribing MTX, including its dose and its concomittent folic acid supplementation.
Objective: To describe the use of MTX in early arthritis in daily clinical practice and to evaluate short-term (6 months) symptomatic efficacy and 12 months structural efficacy.
- Patients: including in the French nationwide cohort of early arthritis (ESPOIR). Patients had to present with inflammatory arthritis lasting for 6 weeks up to 6 months, involving more than 2 joints and diagnosed by the referring physician as RA or RA-like (i.e. a high suspicion of RA).
- Data collected: at baseline patients characteristics and every 6 months symptomatic variables (DAS28,HAQ) and Xrays at baseline and 1 year.
- Analysis: a) Comparison of the patients characteristics with regard to the MTX intake (yes/no)
b) The evaluation of the symptomatic and structural efficacy has been performed by generalized linear regression after adjustement on propensity score (by modelling the start of MTX by disease specific- and demographic variables obtained at baseline, using logistic regression analysis) in the group of patients receiving MTX versus the ones receiving any treatment except leflunomide or sulfazalasine or TNF inhibitors
Result: Within the first 6 months of follow-up of 777 RA patients, 59% received a DMARD which was MTX in 68% (N=313). The mean dose of MTX was 12.7±3.8 mg/week. The folic acid supplementation was given in only 53.7% of the patients. MTX was initiated in patients with more active and severe disease (DAS28: 5.39±1.22 vs 4.83±1.30; HAQ: 1.11±0.68 vs 0.85±0.65; ACPA +: 50% vs 28% ; erosion: 64.5% vs 53%; all p<0.002). After adjustment on the propensity score, MTX was found to be more efficient in terms of both symptomatic and structural end point than control group: change in DAS28 -1.81±1.50 vs -1.54±1.47, p=0.009; change in HAQ -0.51±0.65 vs -0.31±0.62 ,p<0.0001; radiographic progression score 0.88±0.23 vs. 1.60±0.22 units, p=0.031, respectively.
This study confirms the symptomatic and structural efficacy of MTX in early arthritis in daily practice.These data have been observed despite the non-optimal use of MTX including low doses and low frequency of folic acid supplementation.
Disclosure: C. Gaujoux-Viala, None; S. Paternotte, None; B. G. Combe, None; M. Dougados, None.