ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 443

Methotrexate Treatment Strategies in an Early Rheumatoid Arthritis Cohort

Sasha Bernatsky1, Orit Schieir2, Cristiano S. Moura3, Marie-France Valois4, Susan J. Bartlett5, Carol A Hitchon6, Janet E. Pope7, Gilles Boire8, Boulos Haraoui9, Edward C. Keystone10, Diane Tin11, Carter Thorne12 and Vivian P. Bykerk13, 1Divisions of Rheumatology and Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada, 2Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, 31Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada, 4McGill University, Montreal, QC, Canada, 5Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, 6University of Manitoba, Winnipeg, MB, Canada, 7Department of Medicine, Division of Rheumatology, University of Western Ontario, St Joseph's Health Care, London, ON, Canada, 8Rheumatology Division, Centre Hospitalier Universitaire de Sherbrooke and Universite de Sherbrooke, Sherbrooke, QC, Canada, 9Institute de Rheumatologie, Montreal, QC, Canada, 10Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada, 11The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 12University of Toronto, Newmarket, ON, Canada, 132-005, Mt Sinai Hospital, Toronto, ON, Canada

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: ,

Session Information

Date: Sunday, November 5, 2017

Title: Rheumatoid Arthritis – Clinical Aspects Poster I: Treatment Patterns and Response

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Methotrexate (MTX) is recommended as part of initial therapy in early RA, but practices range widely. The objective of this analysis was to describe MTX treatment in an early RA cohort, beginning with initial therapy and assessing time to treatment failure across various treatment strategies.

Methods: We studied adult patients from a prospective multicenter early arthritis cohort (enrolled 2007-2017 within one year of symptom onset) who fulfilled ACR/EULAR RA criteria. RA patients were eligible for our analyses if they initiated MTX (+/-other DMARDs) within 90 days of cohort entry. The first analyses determined time until ‘failure’ of that initial MTX-based therapy, from the time of first initiation, left-censored at cohort entry. Treatment failure definition included: change of route for MTX monotherapy, adding or stopping a DMARD/biologic, and changing dose/frequency of a DMARD or biologic, due to inefficacy or a serious adverse event.

Results: We studied 1,484 early RA patients, the majority initiating either MTX monotherapy (oral or subcutaneous) or MTX plus a second agent (Table 1). At the time of entry into the early arthritis cohort, their mean (standard deviation, SD) age was 54 (15) years, their mean symptom duration was 5.6 months (2.8), their mean DAS28 scores were 5.3 (1.4), and one third (38%) were on oral steroids. Overall, 911/1464 (61%) had a treatment failure, primarily due to inefficacy (Table 1).

Table 1: Distribution of initial treatment and reasons for treatment failure

Treatment

Frequency

%

Length of time remaining on initial treatment (months)*

Any Failure

Drug stopped due to inefficacy

Serious adverse effect

Any side effect§

Median

Range

Oral MTX monotherapy

398

26.8

6.0

0.3 to 95.9

313 (79%)

13 (3.3%)

0 (0%)

70 (17.6%)

Subcutaneous MTX monotherapy

328

22.1

13.1

0.4 to 106.1

146 (45%)

1 (0.3%)

0 (0%)

61 (18.6%)

MTX plus a second DMARD

642

43.3

9.3

0.3 to 107.8

375 (58%)

23 (3.6%)

0 (0%)

168 (26.2%)

MTX-HQN-SSZ

116

7.8

9.8

0.3 to 96.8

77 (66%)

7 (6.0%)

1 (0.9%)

58 (50.0%)

Total

1484

100.0

9.0

0.3 to 107.8

911 (61%)

44 (3.0%)

1 (0.1%)

357 (24.1%)

§ The variable reason to stop, serious adverse events and any side effects are MD recorded.

The multivariate cox regression (Table 2) for the first analyses showed that, compared to oral MTX monotherapy, all MTX strategies had longer time to failure.

Table 2: Adjusted hazard rations (HR) for drug changes after time zero* compared to oral MTX monotherapy (the reference)

Treatment at time zero

Adjusted HR

95% CI

MTX subcutaneous monotherapy

0.91

0.61, 1.35

MTX + another DMARD

0.87

0.62 1.22

MTX+SSZ+HCQ

0.64

0.44, 0.94

Biologics+/- DMARDs including MTX

0.31

0.20, 0.49

Non MTX DMARDs only

1.26

0.89, 1.77

*Adjusting for baseline characteristics: age, sex, co-morbidities, symptom duration, race, education, smoking, erosions, DAS-28, disease activity, corticosteroids, NSAIDs, and COXIBs.

Conclusion: Our data in early RA patients initially exposed to MTX suggest that compared to oral MTX, all other MTX strategies had longer time to failure. These data do not confirm clear differences in outcomes with respect to methotrexate DMARD combinations, as the width of confidence intervals precludes definitive conclusions in this regard.

Disclosure: S. Bernatsky, None; O. Schieir, None; C. S. Moura, None; M. F. Valois, None; S. J. Bartlett, PROMIS, 6,Pfizer Inc, UCB, Lilly, 5; C. A. Hitchon, None; J. E. Pope, AbbVie, Amgen, Bayer, BMS, Celtrion, Eli Lilly and Company, Merck, Novartis, Pfizer, Roche, UCB, 5,Amgen, Bayer, BMS, GSK, Merck, Novartis, Pfizer, Roche, UCB, 2; G. Boire, None; B. Haraoui, AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Merck, Pfizer, Roche, Sandoz, 6,AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, and UCB;, 2,Pfizer, and UCB, 8; E. C. Keystone, Abbott Laboratories, Amgen Inc., AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, UCB, 2,Abbott Laboratories, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, UCB, 5,Amgen, Abbott Laboratories, Astrazeneca LP, Bristol-Myers Squibb Canada,, 8; D. Tin, None; C. Thorne, AbbVie, Amgen, Celgene, Lilly, Novartis, Pfizer, Sanofi, and UCB; has served as a consultant for AbbVie, Amgen, Celgene, Centocor, Genzyme, Hospira, Janssen, Lilly, Medexus/Medac, Merck, Novartis, Pfizer, Sanofi, and UCB, 2,Medexus/Medac, 8; V. P. Bykerk, Amgen, Bristol-Myers Squibb Company, Gilead, Sanofi-Genzyme/Regeneron, Pfizer Pharmaceuticals, UCB, 5.

To cite this abstract in AMA style:

Bernatsky S, Schieir O, Moura CS, Valois MF, Bartlett SJ, Hitchon CA, Pope JE, Boire G, Haraoui B, Keystone EC, Tin D, Thorne C, Bykerk VP. Methotrexate Treatment Strategies in an Early Rheumatoid Arthritis Cohort [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/methotrexate-treatment-strategies-in-an-early-rheumatoid-arthritis-cohort/. Accessed .

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/methotrexate-treatment-strategies-in-an-early-rheumatoid-arthritis-cohort/