Session Information
Date: Sunday, October 21, 2018
Title: Rheumatoid Arthritis – Treatments Poster I: Strategy and Epidemiology
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Short-term glucocorticoids (GCs) along with methotrexate (MTX) has been recommended for newly onset patients with rheumatoid arthritis (RA) in EULAR recommendation 2016. However, it is not always easy to taper or stop oral GCs in clinical practice due to patients’ fear of relapsed pain or fatigue. As well, some patients disagree to increase MTX dose for fear of adverse events. This study was conducted to clarify whether GCs could be reduced without impaired disease control by optimizing MTX dose in RA patients with stable medication in Japanese clinical practice setting.
Methods: Seventy patients with RA who regularly visit our outpatient clinic for ≥ 1yr with stable medication were enrolled during Sep.-Oct. 2016. Clinical characters, disease activity, and medications at entry and 1 year after were collected. Therapeutic strategy was to increase MTX up to 16mg/w with reducing prednisolone (PSL) as much as possible based on patient’s consent. Using biological or targeted synthetic DMARDs was permitted in case of uncontrollable disease. Wilcoxon’s signed-rank test and chi-square test were used for statistics.
Results: Clinical characters (median [IQR]) were; age 62 [51, 68] yrs; female 69%; disease duration 6.8 [3.4, 13.7] yrs. Rate of MTX was elevated from 57 to 62%, and dose (mean±SD) was increased from 9.8±3.2 to 11.6±3.7 mg/w (p<0.0001) for uses only, whereas PSL users was decreased from 56 to 26%, and decreased from 2.0±3.1 to 0.8±1.8 mg/d (p=0.0004) for all patients. Biological or targeted synthetic DMARDs were used for 16 patients, and newly started for 2 patients (tocilizumab and tofacitinib). Median CDAI, SDAI, and DAS28 were suppressed from 5.7 to 3.8, 6.2 to 3.9, and 2.92 to 2.77, and remission rate were increased from 24 to 39%, 27 to 41%, and 36 to 41%, respectively.
Conclusion: Oral GCs were successfully reduced or withdrawn without deteriorated disease control of RA with optimized MTX dose. However, use of oral GCs might delay clinical decision-making of starting biological or targeted synthetic DMARDs.
|
Baseline |
1-Year |
p-value |
|
|
%MTX |
57% |
67% |
0.2226 |
|
MTX[mg/w] for users |
9.8±3.2 |
11.6±3.7 |
<0.0001 |
|
%PSL |
56% |
26% |
0.0003 |
|
PSL[mg/d] for all patients |
2.0±3.1 |
0.8±1.8 |
0.0004 |
|
CDAI value |
6.9±5.9 |
5.3±5.3 |
0.0177 |
|
CDAI remission |
24% |
39% |
0.0687 |
|
SDAI value |
7.8±7.0 |
5.7±5.8 |
0.0038 |
|
SDAI remission |
27% |
41% |
0.075 |
|
DAS28 value |
3.19±1.15 |
2.97±1.13 |
0.0837 |
|
DAS28 remission |
36% |
41% |
0.4874 |
To cite this abstract in AMA style:
Hirata S, Araki K, Kohno H, Yukawa K, Tokunaga T, Kuranobu T, Oi K, Yoshida Y, Sugimoto T, Oda K, Nojima T, Sugiyama E. Practical Optimization of Methotrexate Dose Improves Disease Control of Rheumatoid Arthritis Despite Reduction or Discontinuation of Oral Glucocorticoids [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/practical-optimization-of-methotrexate-dose-improves-disease-control-of-rheumatoid-arthritis-despite-reduction-or-discontinuation-of-oral-glucocorticoids/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/practical-optimization-of-methotrexate-dose-improves-disease-control-of-rheumatoid-arthritis-despite-reduction-or-discontinuation-of-oral-glucocorticoids/