Factors predicting early discontinuation of methotrexate as a first-line treatment for rheumatoid arthritis in Italy: Results from the GISEA registry
Objective: Despite the well-established efficacy of methotrexate (MTX) in rheumatoid arthritis (RA), monotherapy is not sufficient in almost half of patients. The aim of this registry-based study was to detect possible predictive factors for the early failure of MTX as a first-line treatment in earl...
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SAGE Publishing
2019-01-01
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| Series: | Indian Journal of Rheumatology |
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| Online Access: | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2019;volume=14;issue=4;spage=271;epage=276;aulast=Manfredi |
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| author | Andreina Manfredi Marco Sebastiani Florenzo Iannone Elisa Gremese Alessandra Bortoluzzi Ennio Favalli Roberto Gorla Fausto Salaffi Enrico Fusaro Rosario Foti Luca Cantarini Roberto Caporali Alberto Cauli Stefano Alivernini Francesco Paolo Cantatore Antonio Carletto Fabrizio Conti Salvatore D'Angelo1 Oscar Epis Roberta Ramonda Antonio Marchesoni Gianfranco Ferraccioli Giovanni Lapadula |
| author_facet | Andreina Manfredi Marco Sebastiani Florenzo Iannone Elisa Gremese Alessandra Bortoluzzi Ennio Favalli Roberto Gorla Fausto Salaffi Enrico Fusaro Rosario Foti Luca Cantarini Roberto Caporali Alberto Cauli Stefano Alivernini Francesco Paolo Cantatore Antonio Carletto Fabrizio Conti Salvatore D'Angelo1 Oscar Epis Roberta Ramonda Antonio Marchesoni Gianfranco Ferraccioli Giovanni Lapadula |
| author_sort | Andreina Manfredi |
| collection | DOAJ |
| description | Objective: Despite the well-established efficacy of methotrexate (MTX) in rheumatoid arthritis (RA), monotherapy is not sufficient in almost half of patients. The aim of this registry-based study was to detect possible predictive factors for the early failure of MTX as a first-line treatment in early RA patients.
Materials and Methods: Five-hundred and ninety RA patients beginning MTX as the first-line treatment were included. Persistence on therapy was re-evaluated after 12 months. Baseline features of disease were evaluated by means of univariate Cox regression, and parameters significantly associated to the outcome were included in multivariate model.
Results: One hundred and forty-nine patients (25.3%) failed MTX during the 1st year, for inefficacy in 43.6% and adverse events in 37.5% of cases, respectively. At univariate analysis, patients who discontinued or failed treatment showed lower mean age, higher prevalence of anti-citrullinated peptide antibodies (ACPAs), and higher number of tender/swollen joints. The dose of MTX was correlated with the efficacy and the tolerance of the drug. In particular, patients treated with 7.5 mg of MTX weekly showed a higher rate of discontinuation for inefficacy than adverse events, and the contrary was detected for higher doses. On multivariate analysis, age, ACPA, and number of tender joints were directly associated with MTX discontinuation or failure.
Conclusions: More than 25% of RA patients treated with MTX as a first-line therapy failed treatment at 12 months. ACPA positivity, age, and number of tender joints were associated with early withdrawal of MTX in RA patients, while the dose of MTX was correlated to the efficacy and safety of the drug. |
| format | Article |
| id | doaj-art-db97b3d688364b4b8c4ce9664195412a |
| institution | Kabale University |
| issn | 0973-3698 0973-3701 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Indian Journal of Rheumatology |
| spelling | doaj-art-db97b3d688364b4b8c4ce9664195412a2025-01-03T01:45:19ZengSAGE PublishingIndian Journal of Rheumatology0973-36980973-37012019-01-0114427127610.4103/injr.injr_60_19Factors predicting early discontinuation of methotrexate as a first-line treatment for rheumatoid arthritis in Italy: Results from the GISEA registryAndreina ManfrediMarco SebastianiFlorenzo IannoneElisa GremeseAlessandra BortoluzziEnnio FavalliRoberto GorlaFausto SalaffiEnrico FusaroRosario FotiLuca CantariniRoberto CaporaliAlberto CauliStefano AliverniniFrancesco Paolo CantatoreAntonio CarlettoFabrizio ContiSalvatore D'Angelo1Oscar EpisRoberta RamondaAntonio MarchesoniGianfranco FerraccioliGiovanni LapadulaObjective: Despite the well-established efficacy of methotrexate (MTX) in rheumatoid arthritis (RA), monotherapy is not sufficient in almost half of patients. The aim of this registry-based study was to detect possible predictive factors for the early failure of MTX as a first-line treatment in early RA patients. Materials and Methods: Five-hundred and ninety RA patients beginning MTX as the first-line treatment were included. Persistence on therapy was re-evaluated after 12 months. Baseline features of disease were evaluated by means of univariate Cox regression, and parameters significantly associated to the outcome were included in multivariate model. Results: One hundred and forty-nine patients (25.3%) failed MTX during the 1st year, for inefficacy in 43.6% and adverse events in 37.5% of cases, respectively. At univariate analysis, patients who discontinued or failed treatment showed lower mean age, higher prevalence of anti-citrullinated peptide antibodies (ACPAs), and higher number of tender/swollen joints. The dose of MTX was correlated with the efficacy and the tolerance of the drug. In particular, patients treated with 7.5 mg of MTX weekly showed a higher rate of discontinuation for inefficacy than adverse events, and the contrary was detected for higher doses. On multivariate analysis, age, ACPA, and number of tender joints were directly associated with MTX discontinuation or failure. Conclusions: More than 25% of RA patients treated with MTX as a first-line therapy failed treatment at 12 months. ACPA positivity, age, and number of tender joints were associated with early withdrawal of MTX in RA patients, while the dose of MTX was correlated to the efficacy and safety of the drug.http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2019;volume=14;issue=4;spage=271;epage=276;aulast=Manfredianti-citrullinated protein antibodiesmethotrexaterheumatoid arthritistreatment failure |
| spellingShingle | Andreina Manfredi Marco Sebastiani Florenzo Iannone Elisa Gremese Alessandra Bortoluzzi Ennio Favalli Roberto Gorla Fausto Salaffi Enrico Fusaro Rosario Foti Luca Cantarini Roberto Caporali Alberto Cauli Stefano Alivernini Francesco Paolo Cantatore Antonio Carletto Fabrizio Conti Salvatore D'Angelo1 Oscar Epis Roberta Ramonda Antonio Marchesoni Gianfranco Ferraccioli Giovanni Lapadula Factors predicting early discontinuation of methotrexate as a first-line treatment for rheumatoid arthritis in Italy: Results from the GISEA registry Indian Journal of Rheumatology anti-citrullinated protein antibodies methotrexate rheumatoid arthritis treatment failure |
| title | Factors predicting early discontinuation of methotrexate as a first-line treatment for rheumatoid arthritis in Italy: Results from the GISEA registry |
| title_full | Factors predicting early discontinuation of methotrexate as a first-line treatment for rheumatoid arthritis in Italy: Results from the GISEA registry |
| title_fullStr | Factors predicting early discontinuation of methotrexate as a first-line treatment for rheumatoid arthritis in Italy: Results from the GISEA registry |
| title_full_unstemmed | Factors predicting early discontinuation of methotrexate as a first-line treatment for rheumatoid arthritis in Italy: Results from the GISEA registry |
| title_short | Factors predicting early discontinuation of methotrexate as a first-line treatment for rheumatoid arthritis in Italy: Results from the GISEA registry |
| title_sort | factors predicting early discontinuation of methotrexate as a first line treatment for rheumatoid arthritis in italy results from the gisea registry |
| topic | anti-citrullinated protein antibodies methotrexate rheumatoid arthritis treatment failure |
| url | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2019;volume=14;issue=4;spage=271;epage=276;aulast=Manfredi |
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