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Effect of add-on methotrexate in polymyalgia rheumatica patients flaring on glucocorticoids tapering: a retrospective

Diane Marsman1, Thomas Bolhuis2, Nathan den Broeder2

  • 1Department of Rheumatology, Sint Maartenskliniek, PO box 9011, 6500 GM, Nijmegen, The Netherlands. D.marsman@maartenskliniek.nl.

Rheumatology International
|January 24, 2021
PubMed

Insights

Methotrexate (MTX) may not significantly reduce flares in polymyalgia rheumatica (PMR) compared to controls. However, flare rates decreased substantially after MTX initiation, suggesting a potential benefit in real-world PMR management.

Area of Science:

  • Rheumatology
  • Clinical Pharmacology

Background:

  • Current polymyalgia rheumatica (PMR) guidelines suggest early methotrexate (MTX) use, particularly for patients with poorer prognoses.
  • However, robust clinical evidence supporting MTX efficacy in PMR remains limited.

Purpose of the Study:

  • To evaluate the real-world effectiveness of methotrexate (MTX) in managing polymyalgia rheumatica (PMR).

Main Methods:

  • A retrospective study compared newly diagnosed PMR patients initiating MTX with a control group not receiving MTX at the first flare.
  • Outcomes included flares per year (Poisson regression) and daily glucocorticoid (GC) dose (linear regression).

Main Results:

  • The yearly incidence rate ratio of flares between MTX and control groups was 0.80 (95% CI 0.45-1.42).
  • After MTX initiation, the yearly flare rate decreased from 1.22 to 0.43 (incidence ratio 0.35; 95% CI 0.23-0.52).
  • Adjusted daily GC dose was higher in the MTX group (ratio 1.37; 95% CI 1.04-1.80), potentially due to confounding by indication.

Conclusions:

  • No clear effect of MTX on flares was observed when compared to controls, with higher GC doses in the MTX group.
  • Despite this, the significant reduction in flare rates post-MTX initiation suggests a potential beneficial role in real-world PMR treatment.
Keywords:
FlareGlucocorticoid sparingMethotrexatePolymyalgia rheumatica

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