Recently, a group of researchers from Aarhus University in Denmark released study results in which they found that rheumatoid arthritis (RA) patients with high disease activity, older age or a co-morbidity were less likely to restart methotrexate (MTX) treatment after a usage gap of greater than 90 days. The study, entitled, “Methotrexate utilization in Rheumatoid arthritis: A register-based cohort-study of treatment re-starts after gabs of at least 90 days,” was published in the latest edition of the open-access journal SpringerPlus.
The study was conducted in the laboratory of Dr. Kristian Stengaard-Pedersen, MD, DMSc a Professor of Rheumatology at the University of Aarhus and Chief Physician for the Department of Rheumatology, Aarhus University Hospital. Dr. Stengaard-Pedersen’s research is focused on the pathogenesis and treatment of inflammatory diseases such as RA, as well as, the pathogenesis, assessment, and treatment of other musculoskeletal pain syndromes like osteoarthritis and low back pain.
In this study, Dr. Stengaard-Pedersen and his team aimed to understand to what degree RA patients who discontinued MTX treatment for an extensive period (greater than or equal to 90 days) resumed their treatment. The researchers also investigated whether medically important factors such as disease duration, disease activity, and side effects could predict return to MTX treatment.
To achieve these research goals, the investigators utilized the Danish National Patient Registry (DNPR) and identified 788 patients with RA who started MTX between January 1st 1998 and December 31st 2006. These patients were then cross-referenced with the regional Pharmaco Epidemiological Prescription Database (PEPD) to assess drug discontinuation, which was defined as a gap ≥ 90 days from the expiration of one MTX prescription until it was refilled.
The primary study findings showed that among 788 patients who started MTX, 299 patients experienced a gap ≥ 90 days. Other important findings included:
- Within 1.4 years 50 % of the patients who discontinued MTX returned to treatment.
- A total of 66 %patients restarted MTX treatment during the 3 year follow-up.
- Concurrent treatment with corticosteroid and disease-modifying anti-rheumatic drugs (DMARDs) was negatively associated with restarting MTX.
- Older patients were less inclined to restart MTX treatment than middle-aged patients.
- Men were more inclined to restart MTX than women.
In a discussion about the importance of the findings the researchers wrote, “It is a challenge to determine the length of the gap that defines drug discontinuation, and no standard definition exists. Our findings suggest that RA patients frequently stop and restart treatment. We found that especially patients with high disease activity and old age or co-morbidity were less inclined to restart treatment. Hence, addressing MTX utilization and side effects routinely is important in daily clinical practice in order to help patients to remain continuous users.”
