Methotrexate monotherapy versus methotrexate combination therapy with non-biologic disease modifying anti-rheumatic drugs for rheumatoid arthritis

Katchamart, Wanruchada; Trudeau, Judith; Phumethum, Veerapong; Bombardier, Claire

doi:10.1002/14651858.cd008495

Cited by 62 publications

(46 citation statements)

References 42 publications

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“…Cochrane analysis reported the superiority of MTX+LEF combination therapy over MTX mono therapy in improving DAS 28 score and significantly reducing pain over 24 weeks [16].…”

Section: Resultsmentioning

confidence: 99%

Safety and efficacy of Methotrexate Monotherapy Vs Methotrexate Plus Leflunomide Combination Therapy in Early Active Rheumatoid Arthritis Patients

Boshra¹,

Ahmed²,

Salem³

et al. 2016

Med-Science

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“…Cochrane analysis reported the superiority of MTX+LEF combination therapy over MTX mono therapy in improving DAS 28 score and significantly reducing pain over 24 weeks [16].…”

Section: Resultsmentioning

confidence: 99%

Safety and efficacy of Methotrexate Monotherapy Vs Methotrexate Plus Leflunomide Combination Therapy in Early Active Rheumatoid Arthritis Patients

Boshra¹,

Ahmed²,

Salem³

et al. 2016

Med-Science

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“…This finding suggests that a more aggressive approach in the early phases of the disease could obtain better long-term results, even if previous studies on this topic lead to conflicting results (2). In a Cochrane meta-analysis, which compared MTX monotherapy versus MTX combination therapy with nonbiologic DMARDs for RA, a significant improvement in physical function measured by HAQ was found in the MTX combination group, but only in MTX-inadequate responders (16). Conversely, more recent data from the CareRA trial did not show a different effect of MTX in combination with other DMARDs compared to MTX alone on HAQ scores in patients with early RA (17).…”

Section: N Discussionmentioning

confidence: 99%

The impact on disability of initial treatment with methotrexate in patients with rheumatoid arthritis: results from the MARI study

et al. 2016

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The study aimed to assess in a population of subjects with rheumatoid arthritis (RA) treated with methotrexate (MTX) how the initial approach to the treatment influenced subsequent disability. We performed a cross-sectional analysis of data collected during the baseline visit of the MARI study, a multicenter observational study on patients with RA on treatment with MTX for at least 12 months. Subjects who fulfilled the Health Assessment Questionnaire (HAQ) were included in the evaluation. For every patient we retrospectively evaluated the disease duration, the duration of symptoms before the diagnosis, the time elapsed before first MTX treatment, the initial MTX dose, and the concomitant medications in the first six months of therapy. Disability was defined as a DI-HAQ score ≥1. The study population included 1015 subjects. Patients with a DI-HAQ score ≥1 had a longer duration of symptoms before diagnosis, a higher delay in treatment initiation, a lower initial dose of MTX and a more frequent co-treatment with symptomatic drugs. Disability was found less frequently in subjects treated with other concomitant disease modifying anti-rheumatic drugs (DMARDs) but not with biological agents. Logistic regression analysis identified as significant predictors of disability: older age, female sex, a longer time to complete diagnosis, a delay in starting MTX treatment higher than 6 months, and a concomitant treatment with symptomatic drugs, while a combination therapy with other DMARDs was associated with a lower risk of disability. A late diagnosis and a delay in starting a treatment with MTX are associated with poorer functional outcomes in patients with RA.

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“…The recommendation was approved by 94.4% of participants. advantage to combining MTX with other DMARDs compared to MTX alone when treating MTX naïve or MTX non-responder patients (43). The only combination with a better risk/benefit profile than MTX alone was MTX + Hydroxychloroquine + Sulfasalazine (44).…”

Section: Recommendation 9: Methotrexate As the First Choice In Rheumamentioning

confidence: 99%

Systematic review of 2008-2012 literature and update of recommendations for the use of methotrexate in rheumatic diseases, with a focus on rheumatoid arthritis

et al. 2013

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summaryThe objective of this review is to update the recommendations of the 2010 Italian Consensus on the use of methotrexate (MTX) in rheumatoid arthritis (RA) and other rheumatic diseases. The literature published between 2008 and 2012 was systematically reviewed and updated recommendations on MTX use in rheumatic diseases, particularly RA, were formulated. These recommendations were approved by a panel of expert Italian Rheumatologists. A total of 10,238 references were identified, among which 70 studies were selected for critical evaluation. Sufficient evidence had accumulated to warrant changes to several of the recommendations in the new version. A new recommendation for patients with RA who are in MTX-induced clinical remission was also proposed and approved by the panel. Updated recommendations for the use of MTX in patients with RA or other rheumatologic disease are proposed.

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Methotrexate monotherapy versus methotrexate combination therapy with non-biologic disease modifying anti-rheumatic drugs for rheumatoid arthritis

Cited by 62 publications

References 42 publications

Safety and efficacy of Methotrexate Monotherapy Vs Methotrexate Plus Leflunomide Combination Therapy in Early Active Rheumatoid Arthritis Patients

Safety and efficacy of Methotrexate Monotherapy Vs Methotrexate Plus Leflunomide Combination Therapy in Early Active Rheumatoid Arthritis Patients

The impact on disability of initial treatment with methotrexate in patients with rheumatoid arthritis: results from the MARI study

Systematic review of 2008-2012 literature and update of recommendations for the use of methotrexate in rheumatic diseases, with a focus on rheumatoid arthritis

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