Background RA treatment involves starting early with a DMARD. MTX achieves good sustained response in 30–40% of patients (pts). When MTX response is insufficient add other DMARD by achieve RA remission. Different factors may affect the response to MTX
Objectives To analyze the clinical and demographic characteristics related to response to MTX in RA pts DMARD-naïve
Methods We enrolled between 2011 and 2015, pts>18years RA diagnosed (ACR 1987 criteria), treated firs with MTX monotherapy (MTXm). A case-control study (MTXm persistence with CRP-DAS28<3.2 and suspension of MTXm by ineffectiveness or toxicity, respectively) was performed. We collected information that can influence the response to MTXm by medical records review and patient survey. A descriptive and analitical study with SPSS statistics 21 was performed
Results We included 222 pts (70 men and 152 women). The characteristics of cases (123) and controls (99) are shown in the table. The causes of MTXm suspension were remission (7), intolerance/toxicity (19) and inefficiency (79). MTX was discontinued in 40 (18.2%) pts, 28 (12.7%) of them by intolerance/toxicity. Of 123 (55.4%) responders, 71 (32.0%) were CRP-DAS28<2.6. MTXm response was associated with age at onset ≥60 years (χ2 18.47, p<0.01, OR 3.67), rheumatoid factor (RF) <100 IU (χ2 10.92, p<0.01, OR 3.16) and current smoking (χ2 12.71, p<0.01, OR 2.95). Tobacco was associated with RF+ (χ2 8.9 p<0.01 OR 2.59 (1.37; 4.89) and ACPA+ (χ2 4.49 p<0.05 OR 1.88 (1.04, 3.38). We found no association with gender, education, job, coffee, tea or alcoho drinks, comorbidities, cardiovascular risk, possitivity ACPA or FR, RA presentation, treatment delay, or corticosteroid use. We found no correlation between age of RA-onset and RF or ACPA levels and MTXm duration. MTXm persistence at 5 years was 59% pts and their median survival was 93 months (77.14 to 108.8). We only found significant differences in favor of non-smokers and RF<100
Conclusions The initial treatment of RA with MTX is an effective and safe option, with a high drug survival. MTX response was not associated with antibody positivity (RF or ACPA), but it was significantly better in non-smokers patients and RF <100. Smoking cessation could significantly improve the response to MTX of RA patients
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V. K. Ranganath et al. Rheumatology 2013;52:1809–1817.
Disclosure of Interest None declared