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Propensity-adjusted association of methotrexate with overall survival in rheumatoid arthritis

Mary Chester M Wasko1, Abhijit Dasgupta, Helen Hubert

  • 1West Penn Allegheny Health System, Allegheny Singer Research Institute, 4800 Friendship Avenue, North Tower, Suite 2600, Pittsburgh, PA 15224, USA. mcwasko@wpahs.org

Arthritis and Rheumatism
|October 10, 2012
PubMed
Abstract

Insights

Methotrexate (MTX) use in rheumatoid arthritis (RA) patients was linked to a significant 70% reduction in mortality. This finding highlights the survival benefits of MTX in managing RA, even after accounting for patient-specific factors.

Area of Science:

  • Rheumatology
  • Clinical Epidemiology
  • Pharmacovigilance

Background:

  • Rheumatoid arthritis (RA) management involves medications that may impact patient survival.
  • Previous survival models for RA have often overlooked the propensity for medication use, potentially introducing selection bias.
  • Understanding the independent effect of specific RA treatments on mortality is crucial for optimizing patient care.

Purpose of the Study:

  • To investigate the association between methotrexate (MTX) use and mortality risk in patients with rheumatoid arthritis (RA).
  • To control for individual propensity scores for MTX use to mitigate potential selection bias in survival analyses.
  • To examine the impact of MTX duration and discontinuation patterns on RA patient survival.

Main Methods:

  • A prospective cohort study of 5,626 RA patients over 25 years.
  • Time-varying Cox regression models were employed to assess the risk of death associated with MTX use.
  • Individual propensity scores for MTX use were generated using the random forest method and incorporated into multivariate models.

Main Results:

  • A total of 666 deaths (12%) occurred during the 25-year follow-up period.
  • Methotrexate (MTX) use was significantly associated with a reduced risk of death (adjusted hazard ratio: 0.30).
  • The protective association of MTX with mortality was observed for use exceeding one year and was not explained by selective discontinuation before death.

Conclusions:

  • Methotrexate (MTX) use is associated with a substantial 70% reduction in mortality among patients with rheumatoid arthritis (RA).
  • The findings underscore the survival benefits of MTX in RA treatment.
  • Longer duration of MTX use (>1 year) is linked to lower mortality risks in RA patients.

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