Methotrexate (MTX) can significantly reduce the progression of joint damage compared with placebo in symptomatic erosive osteoarthritis of the hand (HOA), according to new research presented at the 2019 American College of Rheumatology (ACR)/Association of Rheumatology Professionals (ARP) Annual Meeting. The findings further suggest, however, that MTX does not have superior efficacy to placebo on pain and function evolution.

“Erosive hand osteoarthritis is a more painful and more debilitating disease,” study author Christian Roux, MD, PhD, a professor of rheumatology at the Université Côte d’Azur in Nice, France, said during a press conference at the ACR/ARP Annual Meeting. “We don’t have any efficient treatments.”

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To reach these conclusions, Dr Roux and colleagues conducted a 1-year prospective, single-center, double-blinded study that comprised 64 patients with symptomatic erosive HOA.

The researchers randomly assigned patients to receive either MTX, 10 mg per week, or placebo.

The dose of MTX, 10 mg, was chosen for the study due to safety concerns, Roux said.

“We were not sure of the safety of methotrexate [in this patient population] because patients were older and had more comorbidities,” he said. “We used 10 mg for the study and maybe it was too low.”

At month 3, the researchers assessed for pain, which was the study’s primary endpoint. No significant difference in the mean decrease in score was observed between the MTX group (17.5 mm) and the placebo group (8.4 mm).

At month 12, the researchers assessed for clinical features, radiographic features, and magnetic resonance imaging (MRI) features.

Erosive joints progressed significantly more to a remodeling phase in the MTX group (27%) than in the placebo group (15%). Additionally, joints with joint space loss appeared to be less eroding in the MTX group (8%) than in the placebo group (29%).

“Our study shows that MTX did not demonstrate superior efficacy over placebo on pain and function evolution at 3 and 12 months in subjects with [erosive HOA],” the researchers wrote in the abstract. “However, MTX significantly reduced the progression of joint damage compared to placebo and seems to facilitate bone remodeling.”

The study authors also determined that interleukin 6 level and synovitis findings on MRI could predict erosive structural evolution of nonerosive joints.

“The presence of systemic and local inflammations at baseline were predictors of erosive progression,” the researchers concluded.

Roux said that the next steps in the research will be a larger study that will include more patients.

“The next steps are an international study with more patients and a higher dose of methotrexate,” he said.

—Colleen Murphy

Reference:

Ferrero S, Wittoek R, Allado E, et al. Methotrexate in patients with hand erosive osteoarthritis refractory to usual treatments: a randomized, double-blind, placebo-controlled trial [abstract 1759]. Arthritis Rheumatol. 2019;71(suppl 10). Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. https://acrabstracts.org/abstract/methotrexate-in-patients-with-hand-erosive-osteoarthritis-refractory-to-usual-treatments-a-randomized-double-blind-placebo-controlled-trial/. Accessed November 10, 2019.