About two-thirds of patients with rheumatoid arthritis (RA) treated with methotrexate remain on the drug after 5 years, Dutch investigators have found. Folic acid supplementation and prednisolone are associated with sustained use.
Dr. Monique Hoekstra and colleagues from Medisch Spectrum Twente in Enschede, the Netherlands, conducted chart reviews to collect data on demographic and clinical factors associated with long-term methotrexate use in patients with RA. Life table analysis and Cox regression analysis were performed to assess methotrexate "survival" and its relation to demographic variables and clinical features.
The researchers analyzed a total of 1072 methotrexate treatment episodes in 1022 RA patients. They report that the cumulative methotrexate survival probabilities after 5 years and 9 years were 64% and 50%, respectively.
The findings are published in the November issue of the Journal of Rheumatology
Univariate analysis demonstrated a significant association between methotrexate survival probability and folic acid supplementation, the attending rheumatologist, concurrent prednisolone use, concurrent sulfasalazine use, and the number of previous disease-modifying antirheumatic drugs (DMARDs) used.
A significant difference in methotrexate survival with and without folic acid supplementation was observed (p < 0.001). The 5-year survival probability with and without folic acid supplementation was 67% and 31%, respectively.
Multivariate analysis showed that folic acid (p < 0.001), rheumatologist (p = 0.002), and concurrent prednisolone use (p = 0.005) remained significantly associated with methotrexate survival.
"Age, disease duration, body mass index, and creatinine clearance were not related to methotrexate survival," Dr. Hoekstra and colleagues report.
They point out that treatment strategies of individual rheumatologists also influence the ability of patients to remain on methotrexate.
Journal reference: J Rheumatol 2003;30:2325-2329.
Source: MedScape Rheumatology news, online at www.medscape.com.
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