Article Text

SAT0261 Which Conventional DMARD to Select in the Treatment of Psoriatic Arthritis (PSA)? Data From Nor-Dmard on 1351 Treatment Courses with Methotrexate (MTX), Sulfasalazine (SSZ) And Leflunomide (LEF)
  1. E. Lie1,
  2. K. M. Fagerli1,
  3. E. Rødevand2,
  4. S. Kalstad3,
  5. K. Mikkelsen4,
  6. A. Wierød5,
  7. D. van der Heijde6,
  8. T. K. Kvien1
  1. 1Diakonhjemmet Hospital, Oslo
  2. 2St. Olavs Hospital, Trondheim
  3. 3University Hospital of Northern Norway, Tromsø
  4. 4Lillehammer Hospital for Rheumatic Diseases, Lillehammer
  5. 5Drammen Hospital, Drammen, Norway
  6. 6Leiden University Medical Center, Leiden, Netherlands


Background MTX is probably the most commonly used DMARD to treat PsA wordwide and a recommended treatment for patients with active disease (1). In a recent publication of a negative placebo-controlled randomised trial of MTX in PsA, it was suggested that the sequencing of conventional DMARDs before biologics should be re-evaluated (2).

Objectives To assess the pattern for use of conventional DMARDs in PsA, and to compare the effectiveness of MTX, SSZ and LEF in a longitudinal observational study (LOS).

Methods Data were extracted from NOR-DMARD, a LOS of arthritis patients starting a new DMARD treatment, with follow-up at 3, 6, 12 months and then yearly. Patients diagnosed with PsA and starting treatment with MTX, SSZ or LEF were identified. We studied baseline characteristics and treatment responses (3 & 6 months) overall, and performed statistical comparisons between treatments including individual patients only. For the latter, the first inclusion per patient was selected. Unadjusted comparisons were done by ANOVA, Kruskall-Wallis or Chi2 test, as appropriate, and analyses with adjustment for important baseline differences were performed by ANCOVA and logistic regression analysis.

Results A total of 1351 prescriptions of MTX (n=1000), SSZ (n=212) and LEF (n=139) in 1212 individual patients were identified – 128 patients were registered with ≥2 of the drugs and 11 patients with all 3 drugs. Among MTX/SSZ/LEF patients 71% vs. 61% vs. 6.5% were DMARD naïve, respectively, and 47% of patients on LEF had failed both MTX and SSZ. Patients treated with LEF also had longer disease duration. Mean baseline DAS28 for MTX/SSZ/LEF was 4.2/4.0/4.3, respectively. The baseline characteristics across groups for the first inclusion per patient (MTX n=949, SSZ n=177, LEF n=86) were very similar (baseline DAS28 4.2/3.9/4.3 for MTX/SSZ/LEF, respectively). Selected 6-month outcomes are shown in the table. Responses were numerically similar for the overall group of patients (n=1351). Comparison of 3-month responses yielded similar results. 2-year drug survival was superior for MTX (0.71) vs. SSZ (0.40; HR 1.96; p<0.001) and LEF (0.29; HR 2.47, p<0.001), with no significant difference between SSZ and LEF.

Conclusions MTX was the most commonly used first-line DMARD while LEF was rarely used as a first-line DMARD. Effectiveness was generally similar, but MTX performed better for some measures, including drug survival.


  1. Gossec L et al, Ann Rheum Dis 2012;71:4-12.

  2. Kingsley G et al, Rheumatology 2012;51:1368-77.

Disclosure of Interest None Declared

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.