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. 2013 Feb;65(2):334-42.
doi: 10.1002/art.37723.

Propensity-adjusted association of methotrexate with overall survival in rheumatoid arthritis

Mary Chester M Wasko  1 , Abhijit Dasgupta, Helen Hubert, James F Fries, Michael M Ward
Affiliations

Propensity-adjusted association of methotrexate with overall survival in rheumatoid arthritis

Mary Chester M Wasko et al. Arthritis Rheum. 2013 Feb.

Erratum in

  • Arthritis Rheum. 2013 May;65(5):1231

Abstract

Objective: While medications used to treat rheumatoid arthritis (RA) may affect survival in RA, few studies take into account the propensity for medication use, which may reflect selection bias in treatment allocation in survival models. We undertook this study to examine the relationship between methotrexate (MTX) use and mortality in RA, after controlling for individual propensity scores for MTX use.

Methods: We studied 5,626 RA patients prospectively for 25 years to determine the risk of death associated with MTX use, modeled in time-varying Cox regression models. We used the random forest method to generate individual propensity scores for MTX use at study entry and during followup in a time-varying manner; these scores were included in the multivariate model. We also investigated whether selective discontinuation of MTX immediately prior to death altered the risk of mortality, and we examined the association of duration of MTX use with survival.

Results: During followup, 666 patients (12%) died. MTX use was associated with reduced risk of death (adjusted hazard ratio 0.30 [95% confidence interval 0.09-1.03]). Selective MTX cessation immediately before death did not account for the protective association of MTX use with mortality. Only MTX use for >1 year was associated with lower risks of mortality, but associations were not stronger with longer durations of use.

Conclusion: MTX use was associated with a 70% reduction in mortality in RA.

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Conflict of interest statement

Dr. Wasko has served as site Principal Investigator for Centocor trials and as consultant to UCB and Centocor. The remaining authors have no potential conflict of interest with regard to the work enclosed herein. No commercial interests have provided support in any fashion for the preparation of this manuscript.

Figures

Figure 1
Figure 1
Hazard ratios and 95% confidence intervals for the association of duration of methotrexate use (as a time-dependent covariate) with survival, based on a multivariate Cox model. All covariates in the base model (shown in Table 2) were included except time-varying propensity for methotrexate use.
See this image and copyright information in PMC

Comment in

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