Higher Disease Activity Score assessing 28 joints (DAS28), current smoking status, and no alcohol consumption are associated with inadequate response to methotrexate plus hydroxychloroquine or tocilizumab in patients with newly-diagnosed rheumatoid arthritis (RA), according to results published in the Annals of the Rheumatic Diseases.

The study included participants with RA who were disease-modifying antirheumatic drug (DMARD)-naive (n=108). Participants were randomly assigned to initiate methotrexate therapy and were treated to target until sustained remission (DAS28 <2.4 with ≤4 swollen joints for ≥24 weeks). If participants did not achieve remission, hydroxychloroquine was added to the treatment regimen and replaced by tocilizumab if remission was still not achieved.

Within 1 year, 52% (n=56) of participants showed inadequate response to methotrexate plus hydroxychloroquine or tocilizumab. The researchers identified DAS28 (adjusted odds ratio [OR], 2.1; 95% CI, 1.4-3.2), current smoking (adjusted OR, 3.02; 95% CI, 1.1-8.0), and alcohol consumption (adjusted OR, 0.4; 95% CI, 0.1-0.9) as baseline predictors.

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“By using easily obtainable clinical predictors, the majority inadequately responding to this therapy can be predicted at baseline, in whom starting combination therapy with a bDMARD (eg, [tocilizumab]) or csDMARD (eg, [sulfasalazine plus hydroxychloroquine]) is a feasible alternative to achieve remission,” the researchers wrote.

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Teitsma XM, Jacobs JWG, Welsing PMJ, et al. Inadequate response to treat-to-target methotrexate therapy in patients with new-onset rheumatoid arthritis: development and validation of clinical predictors [published online May 14, 2018].  Ann Rheum Dis. doi:10.1136/annrheumdis-2018-213035