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THU0135 “indispensable or intolerable?” a retrospective review of methotrexate discontinuation in rheumatoid arthritis
  1. A.J. Badcock1,
  2. A.P. Malaviya2,
  3. A.J. Ostor3
  1. 1Clinical School, University of Cambridge
  2. 2Rheumatology Clinical Research Unit
  3. 3Rheumatology, Addenbrooke’s Hospital, Cambridge, United Kingdom

Abstract

Background Due to its efficacy and safety methotrexate (MTX) has become the first-line disease-modifying drug for rheumatoid arthritis (RA). Its overall tolerability however has not been extensively studied. We addressed this question with real-life data from RA patients treated with MTX.

Objectives To study the prevalence and causes of MTX discontinuation in RA patients in routine clinical practice.

Methods As part of an audit, a retrospective review of our electronic database was undertaken to identify all patients who had received MTX for RA. In those that had stopped treatment, the reasons for this were explored. The dose and duration of MTX therapy was also recorded.

Results 1551 patients on MTX were identified from our rheumatology database. MTX had been stopped in 523 patients (216 in the preceding 24 months). Of these 216 patients, 108 had RA as the primary diagnosis and thus were further analysed. The mean dose at the time of discontinuation of MTX was 14.5mg/week (dose range 2.5-25mg, SD 5.25) (missing data in 19 patients). Abnormal blood results (cytopenias and altered liver function) accounted for 25% of these patients. In approximately 50%, therapy was stopped due to unacceptable symptoms (see table 1). Approximately one in five patients reported feeling “non-specifically unwell” or fatigued. This data relates only to those who discontinued MTX and does not include patients who suffer from side-effects but elect to continue therapy.

Table 1

Conclusions Our study indicates that over time approximately one-third of patients discontinue MTX. Although gastrointestinal and haematological causes are common, up to one in five patients report non-specific symptoms (fatigue, tiredness) as the reason for discontinuation. Further research needs to be directed to identifying those patients who continue MTX despite side-effects, in order to optimise patient adherence and compliance.

Disclosure of Interest None Declared

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