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

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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Reference

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