Is Low-Dose Methotrexate Sufficient in Patients With Rheumatoid Arthritis?

Rheumatoid Arthritis in hands.
Rheumatoid Arthritis in hands.
The efficacy of lower doses of MTX in patients with rheumatoid arthritis in combination with ADA was studied.

Improvements in patient-reported outcomes (PRO) and achievement of low disease activity (LDA)/remission at 6 months in RA were similar when adalimumab (ADA) was combined with either low- or high-dose methotrexate (MTX), according to research presented at the 2017 Annual European Congress of Rheumatology (EULAR), held June 14-17, 2017 in Madrid, Spain.

Between 2003 and 2016, researchers from Columbia University in New York, New York, conducted a real world study with a total of 519 adult patients with RA: 101 patients initiated ADA (40 mg every 2 weeks) with-low dose MTX (≤12.5 mgs), and 418 initiated high-dose MTX (≥15 mgs). The purpose was to determine whether lower doses of MTX would be sufficient in patients with RA.

Patients on high-dose MTX were significantly younger (53.3 vs 59.7), with shorter RA disease duration (8.8 vs 11.2 years) compared with the low-dose MTX group. Patients in the high-dose group also had higher disease activity (mean clinical disease activity index [CDAI]: 20.8 vs 15.4) and more likely to be biologic-naïve (71.3% vs 55.4%), compared with the low-dose group (all P <.05).

“The primary outcomes were mean change in clinical disease activity index (CDAI), and PROs (mHAQ [Modified Health Assessment Questionnaire], pain, fatigue, morning stiffness) from baseline to 6 months,” the investigators reported. “Secondary outcomes included achievement of remission (CDAI≤2.8)/low disease activity (CDAI≤10). Outcomes were evaluated adjusting for covariates that differed at baseline using mixed model linear regression.” Neither adjusted nor unadjusted analyses found any sufficient evidence that patients on high-dose MTX had better improvement in the selected outcomes.

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Pappas D, Griffith J, Schlacher CA, Shan Y, Karki C, Kremer JM. Effectiveness of low and high dose methotrexate in combination with adalimumab in a real world setting: results from the corona rheumatoid arthritis registry. Presented at: 2017 Annual European Congress of Rheumatology (EULAR); June 14-17, 2017; Madrid, Spain. doi:10.1136/annrheumdis-2017-eular.1525