Risk factors for oral methotrexate failure in patients with inflammatory polyarthritis: results from a UK prospective cohort study

Risk factors for oral methotrexate failure in patients with inflammatory polyarthritis: results from a UK prospective cohort study

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Abstract Background Oral methotrexate (MTX) is the first-line therapy for patients with rheumatoid arthritis (RA).However, approximately one quarter of patients discontinue MTX within 12 months.MTX failure, defined as MTX cessation or the addition of another anti-rheumatic drug, is usually due adverse event(s) and/or inefficacy.The aims of this study were to evaluate the rate and predictors of oral MTX failure.Methods Subjects were recruited from the Norfolk Arthritis Register (NOAR), a primary care-based inception cohort of patients with early inflammatory polyarthritis (IP).

Subjects were eligible if they commenced MTX as their first DMARD and were recruited between 2000 and 2008.Patient-reported reasons for MTX failure were recorded and categorised as adverse event, inefficacy or other.The addition of Kitchen Utensils a second DMARD during the study period was categorised as failure due to inefficacy.Cox proportional hazards regression models were used to assess potential predictors of MTX failure, accounting for competing risks.Results A total of 431 patients were eligible.

The probability of patients remaining on MTX at 2 years was 82%.Competing risk analysis revealed that earlier MTX failure due to inefficacy was associated with rheumatoid factor (RF) positivity, younger age at symptom onset and higher baseline disease activity (DAS-28).MTX cessation due to an adverse event was less likely in the RF-positive cohort.Conclusions RF-positive inflammatory polyarthritis patients who are younger with higher baseline disease activity have an increased risk Baby One-Pieces of MTX failure due to inefficacy.Such patients may require combination therapy as a first-line treatment.