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Treatment patterns in rheumatoid arthritis after discontinuation of methotrexate: data from the Ontario Best Practices Research Initiative (OBRI)

1, 2, 3, 4, 5, 6, 7, 8; and the Ontario Best Practices Research Initiative investigators

  1. University of Western Ontario, London; Saint Joseph’s Health Care, London, ON, Canada. janet.pope@sjhc.london.on.ca
  2. JSS Medical Research, St-Laurent, QC, Canada.
  3. JSS Medical Research, St-Laurent, QC; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
  4. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
  5. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
  6. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
  7. JSS Medical Research, St-Laurent, QC; McGill University, Montreal, QC, Canada.
  8. Toronto General Hospital Research Institute, University Health Network, Toronto; Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto; Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada.

CER10349 Submission on line
2018 Vol.36, N°2 - PI 0215, PF 0222
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Rheumatology Article

 

Abstract

OBJECTIVES:
In active rheumatoid arthritis (RA) patients with inadequate response to methotrexate (MTX), guidelines support adding or switching to another conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) and/or a biologic DMARD (bDMARD). The purpose of this analysis was to describe treatment practices in routine care and to evaluate determinants of regimen selection after MTX discontinuation.
METHODS:
Biologic-naïve patients in the Ontario Best Practice Research Initiatives registry discontinuing MTX due to primary/secondary failure, adverse events, or patient/physician decision were included.
RESULTS:
Of 313 patients discontinuing MTX, 102 (32.6%) were on MTX monotherapy, 156 (49.8%) on double, and 55 (17.6%) on multiple csDMARDs. Patients on MTX monotherapy were older than patients on double or multiple csDMARDs (p=0.013), less likely to have joint erosions (p=0.009) and had lower patient global assessment (p=0.046) at MTX discontinuation. Post-MTX discontinuation, 169 (54.0%) transitioned to, or added new DMARD(s) (new csDMARD(s): 139 [44.4%]; bDMARD: 30 [9.6%]), and 144 (46.0%) opted for no new DMARD treatment. Patients on MTX monotherapy transitioning monotherapy, whereas patients on combination csDMARDs switched more to new csDMARDs and bDMARD combination therapy. Early RA (adjOR [95%CI]: 3.07 [1.40–6.72]) and treatment with multiple csDMARDs vs. MTX monotherapy (4.15 [1.35–12.8]) at MTX discontinuation were significant predictors of transitioning to or adding new csDMARD(s)/bDMARD treatment versus opting for no new DMARD treatment.
CONCLUSIONS:
Differences in subsequent treatment patterns exist between patients discontinuing MTX when used as monotherapy versus in combination with other csDMARDs where the former are more likely to use a subsequent monotherapy treatment.

PMID: 29148403 [PubMed]

Received: 20/02/2017 - Accepted : 23/06/2017 - In Press: 23/10/2017 - Published: 18/04/2018