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Extended report
Effectiveness and retention rates of methotrexate in psoriatic arthritis in comparison with methotrexate-treated patients with rheumatoid arthritis
  1. Elisabeth Lie1,
  2. Désirée van der Heijde1,2,
  3. Till Uhlig1,
  4. Marte S Heiberg1,
  5. Wenche Koldingsnes3,
  6. Erik Rødevand4,
  7. Cecilie Kaufmann5,
  8. Knut Mikkelsen6,
  9. Tore K Kvien1
  1. 1Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Rheumatology, University Hospital Northern Norway, Tromsø, Norway
  4. 4Department of Rheumatology, St Olav Hospital, Trondheim, Norway
  5. 5Department of Rheumatology, Buskerud Central Hospital, Drammen, Norway
  6. 6Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
  1. Correspondence to Dr Elisabeth Lie, Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, N-0319 Oslo, Norway; elisabeth_lie{at}


Objective To examine the effectiveness and 2-year retention rates of methotrexate (MTX) in MTX naïve patients with psoriatic arthritis (PsA).

Methods Data on 430 patients with PsA participating in an ongoing longitudinal observational multicentre study in Norway were analysed. 1218 MTX naïve patients with rheumatoid arthritis (RA) from the same study served as a reference population. Assessments included measures of disease activity (28 joint counts, acute phase reactants), health status and utility scores. Six-month effectiveness data were compared both by crude analyses and with adjustments for age, sex and the respective baseline values. Two-year drug survival was compared by Kaplan–Meier and Cox regression analyses.

Results After 6 months of MTX treatment, both patients with PsA and those with RA improved in most disease activity measures and patient reported outcomes. In the adjusted analysis, patients with PsA tended to have less improvement, but changes were in the same range as in patients with RA. Two-year retention rates of MTX therapy in patients with PsA and RA were 65% and 66%, respectively, with only minor differences in reported reasons for discontinuation. Lower age, longer disease duration and higher Modified Health Assessment Questionnaire (MHAQ) score and patient global assessment were independent predictors of MTX termination within the first 2 years of treatment.

Conclusion In this real-life study, MTX treatment was associated with improvement in disease activity and health-related quality of life in patients with PsA after 6 months of treatment. Retention rates of MTX were similar in PsA and RA.

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  • Funding Supported by Eastern Norway Regional Health Authority. The Norwegian Disease-Modifying Antirheumatic Drug study has received unrestricted grant support from Abbott, Amgen, Wyeth, Aventis, MSD, Schering-Plough/Centocor, BristolMyers Squibb, Roche and the Norwegian Directorate for Health and Social Affairs.

  • Competing interests Hans Bijlsma was the Handling Editor for this article.

  • Patient consent Obtained.

  • Ethics approval Patients gave written informed consent before participation. The study was approved by the regional ethical committee and by the Data Inspectorate.

  • Provenance and peer review Not commissioned; externally peer reviewed.