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Efficacy and adverse effects of methotrexate compared with azathioprine in the antisynthetase syndrome

1, 2, 3, 4, 5, 6, 7, 8, 9, 10

 

  1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, and Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  2. National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda; Johns Hopkins University School of Medicine, Baltimore, USA; Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.
  3. Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  4. Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  5. Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  6. Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  7. Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  8. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, and Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  9. Johns Hopkins University School of Medicine, Baltimore, MD, USA. sdanoff@jhmi.edu
  10. Johns Hopkins University School of Medicine, Baltimore, MD, USA. lchrist4@jhmi.edu

CER12114
2019 Vol.37, N°5
PI 0858, PF 0861
Brief Papers

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PMID: 31074729 [PubMed]

Received: 28/01/2019
Accepted : 01/04/2019
In Press: 29/04/2019
Published: 29/08/2019

Abstract

OBJECTIVES:
To study the efficacy in terms of muscle strength, and corticosteroid tapering as well as the prevalence of adverse effects in patients with the antisynthetase syndrome (ASyS) treated with azathioprine (AZA) compared to those treated with methotrexate (MTX).
METHODS:
We compared the clinical outcomes in ASyS patients treated with AZA versus MTX including change in corticosteroid dose, strength, and creatine kinase (CK) as well as the prevalence of adverse effects.
RESULTS:
Among 169 patients with ASyS, 102 were treated at some point exclusively with either AZA or MTX (± corticosteroids). There were no significant differences in the rate of muscle strength recovery, CK decrease or corticosteroid tapering between those ASyS patients treated with MTX versus AZA. The prevalence of adverse events in patients treated with AZA and MTX was similar (29% vs. 25%, p>0.05); elevated liver enzymes (17% AZA vs. 12% MTX) and gastrointestinal involvement (10% AZA vs. 8% MTX) were the most common adverse events. While no patients treated with AZA developed lung complications, two of the patients treated with MTX experienced reversible pneumonitis with MTX cessation.
CONCLUSIONS:
AZA and MTX showed similar efficacy and adverse events in patients with ASyS. Pneumonitis is a rare but important event in patients receiving MTX.

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