Treatment patterns in rheumatoid arthritis after discontinuation of methotrexate: data from the Ontario Best Practices Research Initiative (OBRI).

Authors:
Janet E Pope
Janet E Pope
University of Western Ontario
Canada
Emmanouil Rampakakis
Emmanouil Rampakakis
McGill University
Canada
Mohammad Movahedi
Mohammad Movahedi
Shahid Beheshti University of Medical Sciences
Iran
Angela Cesta
Angela Cesta
Toronto General Hospital Research Institute
Xiuying Li
Xiuying Li
Shanghai Institute of Materia Medica
China
Sandra Couto
Sandra Couto
Toronto General Hospital Research Institute
Toronto | Canada
John S Sampalis
John S Sampalis
McGill University
Canada
Claire Bombardier
Claire Bombardier
University of Toronto
Canada

Clin Exp Rheumatol 2018 Mar-Apr;36(2):215-222. Epub 2017 Oct 23.

Toronto General Hospital Research Institute, University Health Network, Toronto; Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto; Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada.

Objectives: In active rheumatoid arthritis (RA) patients with inadequate response to methotrexate (MTX), guidelines support adding or switching to another conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) and/or a biologic DMARD (bDMARD). The purpose of this analysis was to describe treatment practices in routine care and to evaluate determinants of regimen selection after MTX discontinuation.

Methods: Biologic-naïve patients in the Ontario Best Practice Research Initiatives registry discontinuing MTX due to primary/secondary failure, adverse events, or patient/physician decision were included.

Results: Of 313 patients discontinuing MTX, 102 (32.6%) were on MTX monotherapy, 156 (49.8%) on double, and 55 (17.6%) on multiple csDMARDs. Patients on MTX monotherapy were older than patients on double or multiple csDMARDs (p=0.013), less likely to have joint erosions (p=0.009) and had lower patient global assessment (p=0.046) at MTX discontinuation. Post-MTX discontinuation, 169 (54.0%) transitioned to, or added new DMARD(s) (new csDMARD(s): 139 [44.4%]; bDMARD: 30 [9.6%]), and 144 (46.0%) opted for no new DMARD treatment. Patients on MTX monotherapy transitioning monotherapy, whereas patients on combination csDMARDs switched more to new csDMARDs and bDMARD combination therapy. Early RA (adjOR [95%CI]: 3.07 [1.40-6.72]) and treatment with multiple csDMARDs vs. MTX monotherapy (4.15 [1.35-12.8]) at MTX discontinuation were significant predictors of transitioning to or adding new csDMARD(s)/bDMARD treatment versus opting for no new DMARD treatment.

Conclusions: Differences in subsequent treatment patterns exist between patients discontinuing MTX when used as monotherapy versus in combination with other csDMARDs where the former are more likely to use a subsequent monotherapy treatment.

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Source
June 2018
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