bDMARD drug survival in combination therapy with methotrexate in psoriatic arthritis: A systematic literature review...

Combination therapy with methotrexate (MTX) has shown to improve biologic Disease Modifying Rheumatic Drugs (bDMARD) survival in rheumatoid arthritis, but interest in MTX combination therapy in Psoriatic Arthritis (PsA) remains controversial. We conducted a systematic literature review and meta-analysis to study whether a combination therapy bDMARD and MTX improves bDMARD drug survival in PsA.

We performed a systematic literature review to identify all pertinent articles studying ts/bDMARDs drugs survival [TNF inhibitors (TNFi), IL-17, IL-23, IL-12/23 and JAK inhibitors] and MTX in PsA up until December 2023. Hazard ratio's (HR) were extracted. A random-effect model and inverse-variance method were used. Sensitivity and subgroup analyses were performed to identify sources of heterogeneity and to confirm the robustness of the results.

A total of 2299 records were identified, and twenty studies were included, with a total of 30,634 patients with PsA. All studies were observational. Two studies involved bDMARDs other than TNFi. Combination therapy with MTX was found to be associated with a superior bDMARDs drug survival (HR=0.82 [95% CI: 0.75, 0.89], P-value<0.001, I²=45%) and TNFi drug survival (HR=0.79 [95% CI: 0.73, 0.86], P-value<0.001, I²=27%). A meta-analysis for non-TNFi was not possible due to the limited number of publications.

This meta-analysis shows the positive association between combination therapy bDMARD with MTX and a better bDMARDs drug survival, especially with TNFi. Further studies are needed to confirm this hypothesis with robust evidence such as randomised controlled trials.