A Canadian Retrospective Chart Review Evaluating Concomitant Methotrexate De-escalation Patterns in Patients with...

Area of Science:

• Rheumatology
• Clinical Pharmacology

Background:

• Rheumatoid arthritis (RA) treatment guidelines advocate for methotrexate (MTX)-anchored therapy combined with biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).
• Tolerability issues with MTX can lead to reduced patient adherence, necessitating further investigation into MTX management alongside b/tsDMARDs.
• Limited Canadian data exists on the frequency and impact of MTX tapering or withdrawal after initiating b/tsDMARDs in RA patients.

Purpose of the Study:

• To assess the frequency of methotrexate tapering or withdrawal in Canadian adults with RA after initiating b/tsDMARD therapy.
• To evaluate the impact of MTX dose adjustments on disease status in RA patients receiving b/tsDMARDs.

Main Methods:

• A retrospective chart review was conducted on Canadian adult RA patients.
• Inclusion criteria required at least 3 months of MTX use prior to b/tsDMARD initiation and continuous b/tsDMARD therapy for ≥18 months.
• Patients on >10 mg/day oral prednisone or equivalent were excluded.

Main Results:

• Of 889 patients evaluated, 13.8% tapered MTX and 16.5% discontinued it within 2 years of b/tsDMARD initiation.
• Planned tapering (36.6%) and patient decision (27.2%) were common reasons for MTX dose reduction or cessation.
• Methotrexate dose remained unchanged for 65.5% of patients; 4.2% had their dose increased. Interleukin-6 inhibitors were associated with the highest rates of MTX tapering/discontinuation (34.9%).

Conclusions:

• Methotrexate tapering or withdrawal was observed in 30.4% of Canadian RA patients within two years of initiating b/tsDMARDs.
• Incomplete baseline disease activity data in many records limits comprehensive analysis.
• For patients with available baseline assessments, MTX tapering or discontinuation did not lead to worsening of RA disease activity.