Background Current EULAR and SFR (French Rheumatology Society) guidelines consider MTX as initial gold standard treatment for patients (pts) with RA. They also propose various strategies for MTX inadequate responders, among which the most frequent are optimization of MTX therapy (alone or in combination with other csDMARDs) or biological treatment.
Objectives To explore the strategies applied in daily practice in RA pts with inadequate response to MTX.
Methods STRATEGE is a prospective, observational, multicenter study, conducted in France. Main inclusion criteria were: confirmed RA diagnosis (ACR 1987 or ACR/EULAR 2010 criteria) and treatment by MTX monotherapy with clinical, structural, functional and/or therapeutic evolution leading to therapeutic management modification. Data presented here show the baseline pts characteristics and the therapeutic strategies chosen during the inclusion visit.
Results Between Sept 2014 and July 2015, 176 rheumatologists, mainly with private (49.3%) or mixed private/public (42.1%) practice included 850 pts. Pts baseline characteristics were: mean age: 57.9 yrs (±13.7); RA duration: 5.4 yrs (±6.6); extra-articular manifestations: 10.4%; structural damage: 39.5%; mean DAS28: 3.98 (±1.35), with the following distribution: <2.6 for 12.4%, >3.2 for 75.8% and >5.1 for 17.1%; and mean HAQ: 1.1 (±0.84). All pts were receiving MTX monotherapy and for 83.8% it was the first-line treatment. 67.8% of pts were treated by oral MTX at a mean dose of 14.2 mg/wk (± 4.1), while parenteral mean dose was 16.4 mg/wk (± 3.8). 51.5% of pts treated with parenteral MTX were performing injections by themselves. 15.6% of pts had experience MTX dose tapering before the inclusion. Concomitant treatment included corticosteroids for 44.8% of pts and folic acid for 89.7%. After the inclusion visit, MTX prescription has been identically maintained (dose and route) for 26.2% of pts, interrupted for 2.9% and modified for 70.9% of them. Changes included dose increasing for 47.1%, dose tapering for 6.1% and a route modification for 20.3% (83% oral -> parent). Biologic treatment was initiated for 14.2%, in association with MTX for 95.8%. Other csDMARD treatment was initiated for 1.1% in monotherapy and for 3.8% in association with MTX. The mean dose of MTX after inclusion visit was 16.8 mg/wk (±4.2), with 10.6%, 35.3% and 34.9% pts receiving 10, 15 and 20 mg/wk respectively. The reasons for treatment modification were mainly high disease activity (70.2%), worsening of clinical and biologic parameters (30.8%), remission not achieved (13.1%), radiographic progression (14.1%), steroid dependence (11.4%), and MTX intolerance 4.8%.
Conclusions Consistently with the recent European and National recommendations, first data of the large observational French study STRATEGE, revealed an important place held by initial MTX treatment optimization before initiation of a biotherapy.
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Gaujoux-Viala C, et al. Recommendations of the French Society for Rheumatology for managing RA. Joint Bone Spine 2014; 81(4):287–97
Disclosure of Interest R.-M. Flipo Consultant for: Nordic Pharma, C. Gaujoux-Viala Consultant for: Nordic Pharma, C. Hudry Consultant for: Nordic Pharma, E. Zinovieva Employee of: Nordic Pharma, E. Leutenegger Employee of: Gecem, H. Herman-Demars Employee of: Nordic Pharma