L Idolazzi1, S Adami2, R Capozza3, G Bianchi4, A Cozzolongo5, O Epis6, E Fusaro7, G Lapadula8, A Migliore9, R Pellerito10, A Pucino11, L Sinigaglia12, Elisa Visalli13, Maurizio Rossini2. 1. Rheumatology, Department of Internal Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. luca.idolazzi@univr.it. 2. Rheumatology, Department of Internal Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 3. Rheumatology, Ospedale CTO A. Alesini, ASL Roma C, Rome, Italy. 4. Rheumatology, Ospedale La Colletta, Arenzano, Genoa, Italy. 5. Rheumatology, Ospedale San Paolo, Bari, Italy. 6. Rheumatology, A.O. Ospedale Niguarda Ca' Granda, Milan, Italy. 7. Rheumatology, Azienda Ospedaliero-Universitaria S.Giovanni Battista, Torino, Italy. 8. Rheumatology, Ospedale Policlinico, Bari, Italy. 9. Rheumatology, Ospedale S. Pietro Fatebenefratelli, Rome, Italy. 10. Rheumatology, A.O. Ordine Mauriziano di Torino, ASL TO1, Torino, Italy. 11. Rheumatology, ASL Napoli 1 Centro Distretti 24 -27 -31, Napoli, Italy. 12. Rheumatology, Azienda Ospedaliera Istituto Ortopedico G. Pini, Milano, Italy. 13. Rheumatology, A.O.U. Policlinico Universitario G. Martino, Messina, Italy.
Abstract
OBJECTIVES: Methotrexate (MTX) is the first choice in the treatment of rheumatoid arthritis (RA), but the doses and regimens vary significantly. For this purpose, we conducted an observational study on the use of MTX for RA in Italy (MARI study). METHODS: The MARI study included 1,327 RA patients on MTX treatment for at least 12 months, at 60 Italian rheumatology units. Concomitant medications with corticosteroids, other DMARDs or biological therapies were recorded. The clinical assessment included the Disease Activity Score 28 (DAS28) and the serological positivity for the rheumatoid factor or for the anti-citrullinated protein antibodies. RESULTS: The included patients were treated with either oral (n=288) or parenteral (n=1039) MTX. Only 15.5% of the total number of the patients was on adequate MTX dose (i.e. ≥ 15 mg for the oral route of administration and >12 mg for the parenteral one). The initially established MTX dose was modified in 37.1% of the patients, for intolerance or clinical criteria. A DAS28 remission (DAS28 <2.6) was observed only in 58.5% of the cases, while 52.9% of the patients still presenting an active form of the disease were on suboptimal doses of MTX. CONCLUSIONS: The weekly dose of MTX prescribed for the treatment of RA is often suboptimal, even in conditions of inadequate control of the disease activity. The recommendations for the use of MTX in RA patients should take into account the efficacy and tolerability data derived from its use in real clinical practice.
OBJECTIVES:Methotrexate (MTX) is the first choice in the treatment of rheumatoid arthritis (RA), but the doses and regimens vary significantly. For this purpose, we conducted an observational study on the use of MTX for RA in Italy (MARI study). METHODS: The MARI study included 1,327 RApatients on MTX treatment for at least 12 months, at 60 Italian rheumatology units. Concomitant medications with corticosteroids, other DMARDs or biological therapies were recorded. The clinical assessment included the Disease Activity Score 28 (DAS28) and the serological positivity for the rheumatoid factor or for the anti-citrullinated protein antibodies. RESULTS: The included patients were treated with either oral (n=288) or parenteral (n=1039) MTX. Only 15.5% of the total number of the patients was on adequate MTX dose (i.e. ≥ 15 mg for the oral route of administration and >12 mg for the parenteral one). The initially established MTX dose was modified in 37.1% of the patients, for intolerance or clinical criteria. A DAS28 remission (DAS28 <2.6) was observed only in 58.5% of the cases, while 52.9% of the patients still presenting an active form of the disease were on suboptimal doses of MTX. CONCLUSIONS: The weekly dose of MTX prescribed for the treatment of RA is often suboptimal, even in conditions of inadequate control of the disease activity. The recommendations for the use of MTX in RApatients should take into account the efficacy and tolerability data derived from its use in real clinical practice.
Authors: Ennio Giulio Favalli; Andrea Becciolini; Martina Biggioggero; Ilaria Bertoldi; Chiara Crotti; Maria Gabriella Raimondo; Antonio Marchesoni Journal: Drug Des Devel Ther Date: 2018-05-24 Impact factor: 4.162