Disease Activity, Smoking, Alcohol Consumption Predict Inadequate Methotrexate Response in RA

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.

“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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Reference

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