Suboptimal methotrexate utilization in Chinese patients with inflammatory arthritis: data from a Chinese center

Methotrexate (MTX) is a cornerstone treatment for inflammatory arthritis and its suboptimal usage can lead to low therapeutic response rates. We aim to describe the situation of daily usage of MTX among Chinese patients.

We conducted a retrospective cross-sectional survey in consecutive outpatients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA). A structured questionnaire was developed to collect data on current or previous MTX usage, including dosage, combination therapies, and incidence of side effects. Adherence rates were calculated.

A total of 340 patients with RA and 97 patients with PsA were included. Among them, 276 (81.2%) patients with RA and 78 (80.4%) patients with PsA were currently taking MTX. The average dosage of current MTX use was 9.68 ± 1.65 mg/week in patients with RA and 9.68 ± 1.15 mg/week in patients with PsA, with a range of 2.5-15 mg/week. The adherence rates were 74.6% in RA and 74.4% in PsA. Only 9.8% of patients with RA and 5.1% of patients with PsA received MTX monotherapy currently. MTX withdrawal occurred in 64 (18.8%) patients with RA and 19 (19.6%) in patients with PsA. The major reasons for MTX withdrawal were nausea (33.7%) and abnormal liver function (32.5%). Among the patients who discontinued MTX, 20 (24.1%) patients refused to take MTX due to worrying about the possible side effects.

A high rate of inadequate dosage of MTX was used among Chinese patients with inflammatory arthritis, suggesting that MTX might not fully exert its therapeutic efficacy. Key Points • MTX dosage was inadequate among Chinese patients. • MTX adherence rates were suboptimal.