MTX optimization or adding bDMARD equally improve disease activity in rheumatoid arthritis: results from the prospective study STRATEGE

Abstract

Objectives The STRATEGE study aimed to describe treatment strategies in current practice in RA bDMARD-naive patients with an inadequate response to MTX therapy, and to compare clinical efficacy of the different therapeutic strategies on disease activity after six months. Methods Main inclusion criteria of this prospective, observational, multicentre study were confirmed RA diagnosis, treatment by MTX monotherapy, and need for therapeutic management modification. Results The 722 patients included had a mean (S.D.) RA duration of 5.3 (6.7) years, a mean DAS28 of 4.0 (±1.1); they were all receiving MTX monotherapy, 68% oral, at a mean dose of 15.0 (4.1) mg/wk. Two major strategies were identified: (i) MTX monotherapy dose and/or route optimization (72%) and (ii) bDMARD initiation ± MTX (16%). MTX dosing was modified for 70% of patients, maintained (dose and route) for 28% of patients, and interrupted for 2%. bDMARDs were started when the MTX mean dose was 17.4 mg/wk, 56% parenterally; MTX was maintained concomitantly for 96% of patients. Six-month follow-up results adjusted by propensity score showed that both options were equally successful in improving disease activity and physical function, with 63% and 68% of good-to-moderate EULAR responses, respectively. Conclusion The STRATEGE study shows the importance of initial MTX treatment optimization before initiation of a biological treatment and emphasizes the importance of treat-to-target strategy.

Using ChatGPT-Like Solutions to Bridge the Communication Gap Between Patients With Rheumatoid Arthritis and Health Care Professionals

“…Optimization of methotrexate dose is therefore essential for treating rheumatoid arthritis [ 12 ]. The use of methotrexate monotherapy has shown similar efficacy to the combined use of methotrexate monotherapy with biologic disease–modifying antirheumatic drugs [ 13 ]. Process automation and integration of complementary data, based on solutions such as ChatGPT, could improve outcome prediction, contribute to drug dose optimization, and thus reduce costs to the health care system.…”

Novel insights into the management of rheumatoid arthritis: one year in review 2023

“…Regarding efficacy, in an early RA cohort of patients who did not reach the therapeutic target at six months of MTX monotherapy (68% oral), the same grades of improvement were achieved after optimisation of MTX (dose escalation and switch from oral to parenteral administration) and after the addition of a biological DMARD (bDMARD). Unfortunately, no specific analysis has been conducted on the effect of the route of administration alone on disease activity (7). Interestingly, the TREAT EARLIER study demonstrated that MTX was not able to prevent RA onset in a pre-arthritis cohort of patients presenting with arthralgia and a high risk of developing RA (8).…”