THU0221 Methotrexate Optimization (IE Introduction During the First 3 Months and with Dose Escalation at 6 Months at Least at 20Mg/W or 0.3Mg/Kg/W) is Associated with Better Clinical Outcomes in Daily Practice: Results from the Espoir Cohort. (23rd January 2014)

• Record Type: Journal Article
• Authors: Gaujoux-Viala, C.; Paternotte, S.; Combe, B.; Dougados, M.; Fautrel, B.
• Is Part Of: Annals of the rheumatic diseases. Volume 72:Supplement 3(2013)
• Page Start: A239
• Page End: A239
• Publication Date: 2014-01-23
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2013-eular.749
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Methotrexate(MTX) is recommended as the first DMARD in rheumatoid arthritis (RA) at a weekly dose of 20-25mg in combination with folic acid supplementation. Despite its widespread use and more than two decades of experience, considerable variations exist among rheumatologists in prescribing MTX. Objectives: To describe symptomatic and structural impact of the MTX optimization in early arthritis (EA) in daily clinical practice over 2 years. Methods: - Patients : from the French cohort of EA ESPOIR (at least 2 swollen joints for less than 6 months and suspicion of RA), fulfilling the new ACR-EULAR criteria for RA at baseline, and treated by MTX as first DMARD. - Treatment group: optimized MTX was defined by at least 3 months of MTX during the first 6 months and dose of initiation at least 10 mg/week with escalation at 6 months at least at 20 mg/w or 0.3mg/kg/w if DAS28>2.6 - Outcomes : remissions (Boolean, SDAI and DAS28), functional stability (HAQ≤0.5 and deltaHAQ≤0.25) and absence of radiographic progression (delta Sharp score<1). - Analyses: evaluation of the symptomatic and structural efficacy has been performed by generalized linear regression after adjustement on propensity score (by modelling the optimization of MTX by disease specific- and demographic variables obtained at baseline, using logistic regression analysis) in the group of patients receiving optimized MTX versus the ones receiving MTX without optimization. Results: Within the first year of follow-up of 600 RA patients, 352 received MTX as first DMARD. The mean dose of MTX was 13.1 +/- 3.9 mg/week. In all, 76.1% of patients received at least 3 months of MTX during the first 6 months and 25.3% were treated initially at least by 10 mg/week with escalation at 6 months at least at 20 mg/w or 0.3mg/kg/w if DAS28>2.6; only 22.1% fulfilled the 2 criteria. MTX optimization was initiated in younger patients (45.2 years ± 12.6 vs 49.3 ± 11.3, p=0.009) with higher CRP (29.3±32.0 vs 24.4±36.7, p=0.006). After adjustment, optimized MTX was found to be more efficient in terms of remission and function than control (table). Conclusions: Optimized MTX is more efficacious on remission and function than MTX without optimization in EA in daily practice but without impact on radiographic progression over 2 years. Disclosure of Interest: C. Gaujoux-Viala Grant/research support from: Pfizer, Nordic Pharma, S. Paternotte: None Declared, B. Combe: None Declared, M. Dougados: None Declared, B. Fautrel Grant/research support from: Roche, Pfizer, Nordic Pharma, MSD