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- arthritis, rheumatoid
- tumor necrosis factor inhibitors
- anti-citrullinated protein antibodies
- rheumatoid factor
The benefits of coprescribing methotrexate (MTX) with tumour necrosis factor (TNF)-inhibitors are well documented in rheumatoid arthritis (RA), though rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) status have not always been taken into account.1 Increasing doubt about the value of combination MTX and anti-TNF therapy in psoriatic arthritis2 3 led us to evaluate whether MTX reduced withdrawal rates due to ineffectiveness of anti-TNF therapy equally in seropositive and seronegative RA. Treatment durations for adalimumab or etanercept were analysed for 301 patients with RA using retrospective, real-world data from a single centre. All had started adalimumab or etanercept as a first-line biologic from 2003 onwards. Rates of ineffectiveness-related withdrawal during the first 5 years of anti-TNF therapy were analysed using Kaplan-Meier and Cox regression, with comparison of rates with respect to concomitant MTX at anti-TNF initiation. Fifty-two withdrawals for adverse events and 10 for other reasons constituted censored cases as did 136 still on anti-TNF at 5 years and 60 …
Handling editor Josef S Smolen
Contributors MG and MRE were involved in the design of the study and data interpretation and wrote the manuscript. MG performed the research and collected and analysed the data. MS, S-AY, ER and DM collected, verified and analysed the validation cohort. All authors reviewed and approved the manuscript’s content before submission.
Funding MG (and MRE in part) are supported by the University College London Hospital Biomedical Research Centre (BRC420).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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