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Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic

Hannah den Braanker1,2, Kim Wervers2, Adriana M C Mus2

  • 1Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, Netherlands.

RMD Open
|July 17, 2020
PubMed
Abstract

Insights

Methotrexate (MTX) therapy for psoriatic arthritis (PsA) shows limited sustained efficacy, with only 18% achieving minimal disease activity after one year. Non-responders often exhibit higher IL-23 levels, suggesting a need for personalized treatment strategies.

Area of Science:

  • Rheumatology
  • Immunology
  • Clinical Medicine

Background:

  • Methotrexate (MTX) is the standard first-line treatment for psoriatic arthritis (PsA).
  • Current evidence for MTX efficacy in routine PsA care is limited.
  • Predictors of MTX response in PsA are not well-defined.

Purpose of the Study:

  • To evaluate the real-world efficacy of MTX monotherapy in newly diagnosed PsA patients.
  • To identify clinical and laboratory variables associated with MTX response in PsA.
  • To compare cytokine profiles between MTX responders and non-responders.

Main Methods:

  • Analysis of data from the Dutch southwest Early Psoriatic Arthritis cohoRt (EPAR) study.
  • Inclusion of PsA patients with oligoarthritis or polyarthritis and at least 1-year follow-up.
  • Assessment of disease activity at 6 months and 1 year, with cytokine profiling at baseline, 3, and 6 months.

Main Results:

  • 183 out of 219 (84%) PsA patients initiated MTX monotherapy within 6 months.
  • Only 18% of patients achieved sustained minimal disease activity (MDA) after 1 year of MTX.
  • Non-responders showed significantly higher baseline and on-treatment concentrations of interleukin (IL)-23 and IL-10.

Conclusions:

  • Sustained MDA is achieved by a minority (18%) of PsA patients on long-term MTX monotherapy.
  • Elevated IL-23 levels may indicate an IL-23-driven disease in non-responding PsA patients.
  • Personalized, treat-to-target strategies are crucial for optimizing PsA management.
Keywords:
CytokinesEpidemiologyMethotrexatePsoriatic Arthritis

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