The role of methotrexate co-medication in TNF-inhibitor treatment in patients with psoriatic arthritis: results from 440 patients included in the NOR-DMARD study

Fagerli, K.; Lie, Elisabeth; Heijde, Desirée van der; Heiberg, Marte Schrumpf; Lexberg, Åse Stavland; Rødevand, Erik; Kalstad, Synøve; Mikkelsen, Knut; Kvien, Tore K

doi:10.1136/annrheumdis-2012-202347

Cited by 171 publications

(162 citation statements)

References 22 publications

(27 reference statements)

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“…Although not strongly supported by the evidence thus far and not proposed for the treatment of axial disease by ASAS/EULAR recommendations 19 , a favorable effect of MTX, especially for those with peripheral arthritis, cannot be excluded. Concerning PsA, we and others have found a favorable effect of MTX co-administration 15,20 , while a report from the COnsortium of Rheumatology Researchers Of North America US-based registry found no effect 21 . A systematic literature review showed that the use of MTX prolongs TNFi 23,24 .…”

Section: Rheumatologymentioning

confidence: 59%

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

Flouri

Markatseli²,

Boki³

et al. 2018

J Rheumatol

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Objective.To evaluate the 10-year drug survival of the first tumor necrosis factor inhibitor (TNFi) administered to patients with spondyloarthritis (SpA) overall and comparatively between SpA subsets, and to identify predictors of drug retention.Methods.Patients with SpA in the Hellenic Registry of Biologic Therapies, a prospective multicenter observational cohort, starting their first TNFi between 2004–2014 were analyzed. Kaplan-Meier curves and Cox regression models were used.Results.Overall, 404 out of 1077 patients (37.5%) discontinued treatment (followup: 4288 patient-yrs). Ten-year drug survival was 49%. In the unadjusted analyses, higher TNFi survival was observed in patients with ankylosing spondylitis (AS) compared to undifferentiated SpA and psoriatic arthritis [PsA; significant beyond the first 2.5 (p = 0.003) years and 7 years (p < 0.001), respectively], and in patients treated for isolated axial versus peripheral arthritis (p = 0.001). In all multivariable analyses, male sex was a predictor for longer TNFi survival. Use of methotrexate (MTX) was a predictor in PsA and in patients with peripheral arthritis. Absence of peripheral arthritis and use of a monoclonal antibody (as opposed to non-antibody TNFi) independently predicted longer TNFi survival in axial disease because of lower rates of inefficacy. Achievement of major responses during the first year in either axial or peripheral arthritis was the strongest predictor of longer therapy retention (HR 0.33, 95% CI 0.26–0.41 for Ankylosing Spondylitis Disease Activity Score inactive disease, and HR 0.35, 95% CI 0.24–0.50 for 28-joint Disease Activity Score remission).Conclusion.The longterm retention of the first TNFi administered to patients with SpA is high, especially for males with axial disease. The strongest predictor of longterm TNFi survival is a major response within the first year of treatment.

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Section: Rheumatologymentioning

confidence: 59%

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

Flouri

Markatseli²,

Boki³

et al. 2018

J Rheumatol

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“…However, the influence of MTX in combination with TNF inhibitors has not been well studied in PsA 4 . A study based on observational data from Norway did not detect a difference in clinical responses with the concomitant use of MTX and TNF inhibitors, but the authors stressed that they did not have the data to address the issue of peripheral versus axial disease, a major potential confounding factor 8 .…”

Section: Discussionmentioning

confidence: 99%

“…To further analyze drug tolerability, we examined withdrawal rates during the 24 months of therapy. Other studies in patients with PsA have found that MTX increases the rate of persistence with anti-TNF therapy 6,7,8 and that PsA patients treated with ADA plus MTX have higher serum concentrations of ADA than those treated with ADA alone 16,17 , possibly due to suppression of development of anti-ADA antibody. However, our findings do not support an increased rate of treatment persistence with ADA in patients receiving concomitant MTX.…”

Section: Rheumatologymentioning

confidence: 94%

“…There is some evidence that MTX may contribute to improved treatment persistence with anti-TNF therapy 6,7 , particularly when used in combination with infliximab, but there are few data to support a benefit in effectiveness outcomes in patients with PsA treated with concomitant MTX and TNF inhibitors, including adalimumab (ADA) 8,9 . Consequently, the latest European League Against Rheumatism guidelines for the pharmacologic management of PsA include studies of combination therapies with conventional disease-modifying antirheumatic drugs (DMARD) and biologic agents on the research agenda 10 .…”

mentioning

confidence: 99%

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Does Concomitant Methotrexate with Adalimumab Influence Treatment Outcomes in Patients with Psoriatic Arthritis? Data from a Large Observational Study

Behrens

Koehm²,

Arndt³

et al. 2015

J Rheumatol

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Objective.To examine the influence of concomitant methotrexate (MTX) with adalimumab (ADA) on outcomes in patients with psoriatic arthritis (PsA) using data from an observational study of ADA.Methods.Data from a German noninterventional study of patients with PsA starting treatment with ADA were analyzed retrospectively for effects of concomitant MTX on key outcomes, including Disease Activity Score-28 joints, tender and swollen joint counts, skin assessments, and safety. Patients were categorized into those with symptoms of axial involvement and those with no symptoms of axial involvement as judged by the examining clinician.Results.A total of 1455 patients met the study criteria, 296 with axial involvement (ADA monotherapy = 165; plus MTX = 131) and 1159 with no axial involvement (ADA monotherapy = 658; plus MTX = 501). ADA, alone or combined with MTX, resulted in strong and comparable reductions in disease activity measures in patients with and those without axial disease over 24 months of therapy. In multiple regression analyses, concomitant MTX did not affect joint or skin outcomes in either the group with axial manifestations or the group without axial disease. Neither adverse event rates nor withdrawal rates were significantly influenced by concomitant MTX.Conclusion.ADA is an effective treatment option for patients with PsA with or without axial involvement. Compared with ADA monotherapy, the use of concomitant MTX with ADA does not improve articular or skin outcomes in patients with PsA regardless of axial symptoms. Trial registration: Clinicaltrials.govNCT01111240

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“…This has been studied in the Norwegian, Swedish, and CORRONA PsA registries in relation to etanercept (ETN), ADA, and IFX 14,15,16 . IFX survival is more prolonged when MTX is combined compared to IFX monotherapy.…”

mentioning

confidence: 99%

Do Biologic-treated Psoriatic Arthritis Patients with Spondylitis Respond Differently with or without Concomitant Methotrexate from Patients without Spondylitis?

Mease

2016

J Rheumatol

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The role of methotrexate co-medication in TNF-inhibitor treatment in patients with psoriatic arthritis: results from 440 patients included in the NOR-DMARD study

Cited by 171 publications

References 22 publications

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

Does Concomitant Methotrexate with Adalimumab Influence Treatment Outcomes in Patients with Psoriatic Arthritis? Data from a Large Observational Study

Do Biologic-treated Psoriatic Arthritis Patients with Spondylitis Respond Differently with or without Concomitant Methotrexate from Patients without Spondylitis?

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