Combination MTX With TNF Lowers Discontinuation Rates

A recent study highlighted the persistence of treatment with methotrexate and tumor necrosis factor (TNF) inhibitors among patients with spondyloarthritis compared with rheumatoid arthritis (RA). The findings demonstrated longer persistence of methotrexate among patients with RA, and that concomitant use of methotrexate with TNF inhibitors lowered the rates of discontinuation.

Using data from the Optum deidentified Clinformatics Data Mart Database from 2000 to 2014, the researchers identified patients with RA, psoriatic arthritis (PsA), and ankylosing spondylitis (AS) without prior biologic use who initiated methotrexate (n=31,527) or a TNF inhibitor (n=34,651). They compared the time to medication discontinuation over the next 2 years between patients with RA, PsA, or AS using Cox proportional hazard models, adjusting for potential confounders. In addition, they assessed whether concomitant use of conventional synthetic disease-modifying antirheumatic drugs (csDMARD) was associated with TNF inhibitor persistence.
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The researchers found methotrexate was discontinued sooner among patients with PsA (adjusted hazard ratio [aHR] 1.10; 95% CI, 1.04-1.16) and AS (aHR 1.23; 95% CI, 1.16-1.31) compared with RA. For TNF inhibitors, the discontinuation rates were similar for RA and AS, while discontinuation of therapies occurred later in PsA (aHR 0.93; 95% CI, 0.89-0.97).

Lower rates of TNF inhibitor discontinuation were associated with concomitant use of methotrexate compared with csDMARD among patients with RA (aHR 0.85; 95% CI, 0.80-0.89), PsA (aHR 0.81; 95% CI, 0.74-0.89), and AS (aHR 0.79; 95% CI 0.67-0.93).

“Methotrexate discontinuation occurs sooner in patients with PsA and AS versus RA. Concomitant use of Methotrexate with a TNF inhibitor, however, is associated with improved TNF inhibitor persistence in all 3 diseases,” the researchers concluded.

Reference

George MD, Baker JF, Ogdie A. Comparative persistence of methotrexate and tumor necrosis factor inhibitors in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis [published online Sept 1, 2019]. J Rheumatol. doi:10.3899/jrheum.190299