OBJECTIVE: Several seminal studies have suggested that a combination therapy of biologics with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) improve disease outcomes in rheumatoid arthritis (RA). Hence, most guidelines reflect this practice. It has also been shown that methotrexate (MTX) at a dose of 8-10 mg/week is perhaps sufficient to achieve better outcomes in early RA. However, it is not clear whether this strategy enhances biologic retention in the patients with established RA. We present a real-world retrospective study to investigate whether csDMARD co-prescription improves biologic retention and the optimal dose to preserve such response. MATERIALS AND METHODS: All patients prescribed biologic therapy for RA at our center between 2003 and 2017 were identified through the departmental database. They were split into five groups based on a weekly MTX dose (≤7.5 mg, 10-17.5 mg, ≥20 mg), other csDMARD prescription, or biologic monotherapy. The one-way analysis of variance model for independent values was utilized to ascertain the significance of data. The Mann-Whitney two-tailed U test was employed to determine the significance of relationship between the monotherapy group and other arms. The significance level was predefined at 0.05. RESULTS: A total of 168 patients with 198 biologic events were included. The mean age was 59.4 years (range, 24-90 years). 78% were women. The mean disease duration was 155.6 months (range, 15-491). There was a statistically significant difference (p=0.03) in biologic retention among the five arms. Compared to monotherapy, the data remained significant for ≥20 mg MTX and csDMARD groups; however, the biologic retention in the other two MTX arms was not significant. There was no significant relationship among groups for DAS28 improvement (p=0.24). CONCLUSION: Our results suggest that to improve biologic retention, the MTX dose should be increased to 20 mg a week or more, and, in people with MTX intolerance, csDMARDs co-presciption can be an alternative strategy. Maintenance with a low-to-moderate MTX dose can lead to poorer retention rates.
OBJECTIVE: Several seminal studies have suggested that a combination therapy of biologics with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) improve disease outcomes in rheumatoid arthritis (RA). Hence, most guidelines reflect this practice. It has also been shown that methotrexate (MTX) at a dose of 8-10 mg/week is perhaps sufficient to achieve better outcomes in early RA. However, it is not clear whether this strategy enhances biologic retention in the patients with established RA. We present a real-world retrospective study to investigate whether csDMARD co-prescription improves biologic retention and the optimal dose to preserve such response. MATERIALS AND METHODS: All patients prescribed biologic therapy for RA at our center between 2003 and 2017 were identified through the departmental database. They were split into five groups based on a weekly MTX dose (≤7.5 mg, 10-17.5 mg, ≥20 mg), other csDMARD prescription, or biologic monotherapy. The one-way analysis of variance model for independent values was utilized to ascertain the significance of data. The Mann-Whitney two-tailed U test was employed to determine the significance of relationship between the monotherapy group and other arms. The significance level was predefined at 0.05. RESULTS: A total of 168 patients with 198 biologic events were included. The mean age was 59.4 years (range, 24-90 years). 78% were women. The mean disease duration was 155.6 months (range, 15-491). There was a statistically significant difference (p=0.03) in biologic retention among the five arms. Compared to monotherapy, the data remained significant for ≥20 mg MTX and csDMARD groups; however, the biologic retention in the other two MTX arms was not significant. There was no significant relationship among groups for DAS28 improvement (p=0.24). CONCLUSION: Our results suggest that to improve biologic retention, the MTX dose should be increased to 20 mg a week or more, and, in people with MTX intolerance, csDMARDs co-presciption can be an alternative strategy. Maintenance with a low-to-moderate MTX dose can lead to poorer retention rates.
Authors: Sandra L Goss; Cheri E Klein; Ziyi Jin; Charles S Locke; Ramona C Rodila; Hartmut Kupper; Gerd-Rudiger Burmester; Walid M Awni Journal: Clin Ther Date: 2018-02 Impact factor: 3.393
Authors: Jie Zhang; Fenglong Xie; Elizabeth Delzell; Huifeng Yun; James D Lewis; Kevin Haynes; Lang Chen; Timothy Beukelman; Kenneth G Saag; Jeffrey R Curtis Journal: Arthritis Care Res (Hoboken) Date: 2015-05 Impact factor: 4.794
Authors: Juan J Gómez-Reino; Carlos Rodríguez-Lozano; Cristina Campos-Fernández; María Montoro; Miguel Ángel Descalzo; Loreto Carmona Journal: Ann Rheum Dis Date: 2011-10-13 Impact factor: 19.103
Authors: Josef S Smolen; Robert Landewé; Johannes Bijlsma; Gerd Burmester; Katerina Chatzidionysiou; Maxime Dougados; Jackie Nam; Sofia Ramiro; Marieke Voshaar; Ronald van Vollenhoven; Daniel Aletaha; Martin Aringer; Maarten Boers; Chris D Buckley; Frank Buttgereit; Vivian Bykerk; Mario Cardiel; Bernard Combe; Maurizio Cutolo; Yvonne van Eijk-Hustings; Paul Emery; Axel Finckh; Cem Gabay; Juan Gomez-Reino; Laure Gossec; Jacques-Eric Gottenberg; Johanna M W Hazes; Tom Huizinga; Meghna Jani; Dmitry Karateev; Marios Kouloumas; Tore Kvien; Zhanguo Li; Xavier Mariette; Iain McInnes; Eduardo Mysler; Peter Nash; Karel Pavelka; Gyula Poór; Christophe Richez; Piet van Riel; Andrea Rubbert-Roth; Kenneth Saag; Jose da Silva; Tanja Stamm; Tsutomu Takeuchi; René Westhovens; Maarten de Wit; Désirée van der Heijde Journal: Ann Rheum Dis Date: 2017-03-06 Impact factor: 19.103