Methotrexate treatment in early psoriatic arthritis in comparison to rheumatoid arthritis : an observational nationwide study
(2023) In RMD Open 9(2).- Abstract
Introduction We aimed to compare the proportions of patients with newly diagnosed psoriatic arthritis (PsA) and rheumatoid arthritis (RA) remaining on methotrexate (regardless of other disease-modifying antirheumatic drug (DMARD)-changes), and proportions not having started another DMARD (regardless of methotrexate discontinuation), within 2 years of starting methotrexate, as well as methotrexate effectiveness. Methods Patients with DMARD-naïve, newly diagnosed PsA, starting methotrexate 2011-2019, were identified from high-quality national Swedish registers and matched 1:1 to comparable patients with RA. Proportions remaining on methotrexate and not starting another DMARD were calculated. For patients with disease activity data at... (More)
Introduction We aimed to compare the proportions of patients with newly diagnosed psoriatic arthritis (PsA) and rheumatoid arthritis (RA) remaining on methotrexate (regardless of other disease-modifying antirheumatic drug (DMARD)-changes), and proportions not having started another DMARD (regardless of methotrexate discontinuation), within 2 years of starting methotrexate, as well as methotrexate effectiveness. Methods Patients with DMARD-naïve, newly diagnosed PsA, starting methotrexate 2011-2019, were identified from high-quality national Swedish registers and matched 1:1 to comparable patients with RA. Proportions remaining on methotrexate and not starting another DMARD were calculated. For patients with disease activity data at baseline and 6 months, response to methotrexate monotherapy was compared through logistic regression, applying non-responder imputation. Results In total, 3642/3642 patients with PsA/RA were included. Baseline patient-reported pain and global health were similar, whereas patients with RA had higher 28-joint scores and evaluator-assessed disease activity. Two years after methotrexate start, 71% of PsA vs 76% of patients with RA remained on methotrexate, 66% vs 60% had not started any other DMARD, and 77% vs 74% had not started specifically a biological or targeted synthetic DMARD. At 6 months, the proportions of patients with PsA versus RA achieving pain-scores ≤15 mm were 26% vs 36%; global health ≤20 mm: 32% vs 42%; evaluator-assessed 'remission': 20% vs 27%, with corresponding adjusted ORs (PsA vs RA) of 0.63 (95% CI 0.47 to 0.85); 0.57 (95% CI 0.42 to 0.76) and 0.54 (95% CI 0.39 to 0.75). Discussion In Swedish clinical practice, methotrexate use is similar in PsA and RA, both regarding initiation of other DMARDs and methotrexate retention. On a group level, disease activity improved during methotrexate monotherapy in both diseases, although more so in RA.
(Less)
- author
- Lindström, Ulf ; Di Giuseppe, Daniela ; Exarchou, Sofia LU ; Alenius, Gerd Marie ; Olofsson, Tor LU ; Klingberg, Eva ; Jacobsson, Lennart LU ; Askling, Johan and Wallman, Johan K. LU
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Arthritis, Psoriatic, Arthritis, Rheumatoid, Methotrexate
- in
- RMD Open
- volume
- 9
- issue
- 2
- article number
- e002883
- publisher
- BMJ Publishing Group
- external identifiers
-
- scopus:85159738432
- pmid:37173095
- ISSN
- 2056-5933
- DOI
- 10.1136/rmdopen-2022-002883
- language
- English
- LU publication?
- yes
- id
- dbb09249-2102-4b3f-901a-0b6230a24fa0
- date added to LUP
- 2023-08-21 14:47:08
- date last changed
- 2024-06-15 06:19:15
@article{dbb09249-2102-4b3f-901a-0b6230a24fa0,
abstract = {{<p>Introduction We aimed to compare the proportions of patients with newly diagnosed psoriatic arthritis (PsA) and rheumatoid arthritis (RA) remaining on methotrexate (regardless of other disease-modifying antirheumatic drug (DMARD)-changes), and proportions not having started another DMARD (regardless of methotrexate discontinuation), within 2 years of starting methotrexate, as well as methotrexate effectiveness. Methods Patients with DMARD-naïve, newly diagnosed PsA, starting methotrexate 2011-2019, were identified from high-quality national Swedish registers and matched 1:1 to comparable patients with RA. Proportions remaining on methotrexate and not starting another DMARD were calculated. For patients with disease activity data at baseline and 6 months, response to methotrexate monotherapy was compared through logistic regression, applying non-responder imputation. Results In total, 3642/3642 patients with PsA/RA were included. Baseline patient-reported pain and global health were similar, whereas patients with RA had higher 28-joint scores and evaluator-assessed disease activity. Two years after methotrexate start, 71% of PsA vs 76% of patients with RA remained on methotrexate, 66% vs 60% had not started any other DMARD, and 77% vs 74% had not started specifically a biological or targeted synthetic DMARD. At 6 months, the proportions of patients with PsA versus RA achieving pain-scores ≤15 mm were 26% vs 36%; global health ≤20 mm: 32% vs 42%; evaluator-assessed 'remission': 20% vs 27%, with corresponding adjusted ORs (PsA vs RA) of 0.63 (95% CI 0.47 to 0.85); 0.57 (95% CI 0.42 to 0.76) and 0.54 (95% CI 0.39 to 0.75). Discussion In Swedish clinical practice, methotrexate use is similar in PsA and RA, both regarding initiation of other DMARDs and methotrexate retention. On a group level, disease activity improved during methotrexate monotherapy in both diseases, although more so in RA.</p>}},
author = {{Lindström, Ulf and Di Giuseppe, Daniela and Exarchou, Sofia and Alenius, Gerd Marie and Olofsson, Tor and Klingberg, Eva and Jacobsson, Lennart and Askling, Johan and Wallman, Johan K.}},
issn = {{2056-5933}},
keywords = {{Arthritis, Psoriatic; Arthritis, Rheumatoid; Methotrexate}},
language = {{eng}},
number = {{2}},
publisher = {{BMJ Publishing Group}},
series = {{RMD Open}},
title = {{Methotrexate treatment in early psoriatic arthritis in comparison to rheumatoid arthritis : an observational nationwide study}},
url = {{http://dx.doi.org/10.1136/rmdopen-2022-002883}},
doi = {{10.1136/rmdopen-2022-002883}},
volume = {{9}},
year = {{2023}},
}