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. 2015 Oct 8;1(1):e000147.
doi: 10.1136/rmdopen-2015-000147. eCollection 2015.

Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors: data from the DREAM registry

Sofie H M Manders  1 , Mart A F J van de Laar  2 , Sanne A A Rongen-van Dartel  3 , Reinhard Bos  4 , Henk Visser  5 , Herman L Brus  6 , Tim Jansen  7 , Harald E Vonkeman  2 , Piet L C M van Riel  1 , Wietske Kievit  8
Affiliations

Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors: data from the DREAM registry

Sofie H M Manders et al. RMD Open. .

Abstract

Objectives: To study the number of patients that taper or discontinue concomitant methotrexate (MTX) in daily practice in patients with rheumatoid arthritis (RA) treated with tumour necrosis factor inhibitor (TNFi) and to analyse the effects of that adaption on disease activity and drug survival.

Methods: Data were collected from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Patients who started their first TNFi were included in the study. Treatment effectiveness after MTX tapering or discontinuation was analysed using Disease Activity Score of 28 joints (DAS28). Drug survival of the TNFi was analysed using the Cox proportional hazard model with a time-dependent covariate.

Results: In 458 patients (34%), MTX was tapered, 126 patients (10%) discontinued MTX and 747 patients (56%) continued MTX at the same dose. On average, DAS28 improved after tapering MTX (-0.40, -0.45) and after stopping MTX (-0.28, -0.12) at 6 and 12 months. In the taper group, 21% of the patients relapsed (DAS28 increase >0.6), and in the discontinuation group this was 21% and 24% at 6 and 12 months, respectively. Patients who taper and discontinue MTX have a similar DAS28 score over time as patients who continue MTX. Moreover, there was no influence of tapering or discontinuation of MTX on long-term drug survival of TNFi.

Conclusions: In daily practice, tapering or discontinuation of concomitant MTX in patients with RA treated with TNFi frequently occurs and it does not seem to influence the average DAS28 over time or the long-term TNFi drug survival. It appears that in daily clinical practice the correct patients are selected to taper or discontinue MTX.

Keywords: Anti-TNF; DAS28; Methotrexate; Outcomes research; Rheumatoid Arthritis.

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Figures

Figure 1
Figure 1
Predicted DAS28 scores over time from start with TNFi, separately for patients that discontinue, taper and continue MTX.
See this image and copyright information in PMC

References

    1. Breedveld FC, Weisman MH, Kavanaugh AF et al. The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum 2006;54:26–37. 10.1002/art.21519 - DOI - PubMed
    1. Klareskog L, Van Der Heijde D, De Jager JP et al. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet 2004;363:675–81. 10.1016/S0140-6736(04)15640-7 - DOI - PubMed
    1. Van Der Heijde D, Klareskog L, Rodriguez-Valverde V et al. Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: two-year clinical and radiographic results from the TEMPO study, a double-blind, randomized trial. Arthritis Rheum 2006;54:1063–74. 10.1002/art.21655 - DOI - PubMed
    1. Smolen JS, Landewe R, Breedveld FC et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2014;73:492–509. 10.1136/annrheumdis-2013-204573 - DOI - PMC - PubMed
    1. Harrison MJ, Lunt M, Verstappen SMM et al. Exploring the validity of estimating EQ-5D and SF-6D utility values from the health assessment questionnaire in patients with inflammatory arthritis. Health Qual Life Outcomes 2010;8:21 10.1186/1477-7525-8-21 - DOI - PMC - PubMed

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