Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors: Data from the DREAM registry

Sofie H.M. Manders; Mart A.F.J. van de Laar; Sanne A.A. Rongen-van Dartel; Reinhard Bos; Henk Visser; Herman L. Brus; Tim Jansen; Harald E. Vonkeman; Piet L.C.M. van Riel; Wietske Kievit

doi:10.1136/rmdopen-2015-000147

Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors: Data from the DREAM registry

Sofie H.M. Manders^*, Mart A.F.J. van de Laar, Sanne A.A. Rongen-van Dartel, Reinhard Bos, Henk Visser, Herman L. Brus, Tim Jansen, Harald E. Vonkeman, Piet L.C.M. van Riel, Wietske Kievit

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objectives: To study the number of patients that taper or discontinue concomitant methotrexate (MTX) in daily practice in patients with rheumatoid arthritis (RA) treated with tumour necrosis factor inhibitor (TNFi) and to analyse the effects of that adaption on disease activity and drug survival.

Methods: Data were collected from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Patients who started their first TNFi were included in the study. Treatment effectiveness after MTX tapering or discontinuation was analysed using Disease Activity Score of 28 joints (DAS28). Drug survival of the TNFi was analysed using the Cox proportional hazard model with a time-dependent covariate.

Results: In 458 patients (34%), MTX was tapered, 126 patients (10%) discontinued MTX and 747 patients (56%) continued MTX at the same dose. On average, DAS28 improved after tapering MTX (-0.40, -0.45) and after stopping MTX (-0.28, -0.12) at 6 and 12 months. In the taper group, 21% of the patients relapsed (DAS28 increase >0.6), and in the discontinuation group this was 21% and 24% at 6 and 12 months, respectively. Patients who taper and discontinue MTX have a similar DAS28 score over time as patients who continue MTX. Moreover, there was no influence of tapering or discontinuation of MTX on long-term drug survival of TNFi.

Conclusions: In daily practice, tapering or discontinuation of concomitant MTX in patients with RA treated with TNFi frequently occurs and it does not seem to influence the average DAS28 over time or the long-term TNFi drug survival. It appears that in daily clinical practice the correct patients are selected to taper or discontinue MTX.

Original language	English
Article number	e000147
Journal	RMD Open
Volume	1
Issue number	1
DOIs	https://doi.org/10.1136/rmdopen-2015-000147
Publication status	Published - 8 Oct 2015

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Manders, S. H. M., van de Laar, M. A. F. J., Rongen-van Dartel, S. A. A., Bos, R., Visser, H., Brus, H. L., Jansen, T., Vonkeman, H. E., van Riel, P. L. C. M., & Kievit, W. (2015). Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors: Data from the DREAM registry. RMD Open, 1(1), Article e000147. https://doi.org/10.1136/rmdopen-2015-000147

@article{ea5fb964105841da82cdc04f1049b10b,

title = "Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors: Data from the DREAM registry",

abstract = "Objectives: To study the number of patients that taper or discontinue concomitant methotrexate (MTX) in daily practice in patients with rheumatoid arthritis (RA) treated with tumour necrosis factor inhibitor (TNFi) and to analyse the effects of that adaption on disease activity and drug survival.Methods: Data were collected from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Patients who started their first TNFi were included in the study. Treatment effectiveness after MTX tapering or discontinuation was analysed using Disease Activity Score of 28 joints (DAS28). Drug survival of the TNFi was analysed using the Cox proportional hazard model with a time-dependent covariate.Results: In 458 patients (34%), MTX was tapered, 126 patients (10%) discontinued MTX and 747 patients (56%) continued MTX at the same dose. On average, DAS28 improved after tapering MTX (-0.40, -0.45) and after stopping MTX (-0.28, -0.12) at 6 and 12 months. In the taper group, 21% of the patients relapsed (DAS28 increase >0.6), and in the discontinuation group this was 21% and 24% at 6 and 12 months, respectively. Patients who taper and discontinue MTX have a similar DAS28 score over time as patients who continue MTX. Moreover, there was no influence of tapering or discontinuation of MTX on long-term drug survival of TNFi.Conclusions: In daily practice, tapering or discontinuation of concomitant MTX in patients with RA treated with TNFi frequently occurs and it does not seem to influence the average DAS28 over time or the long-term TNFi drug survival. It appears that in daily clinical practice the correct patients are selected to taper or discontinue MTX.",

author = "Manders, {Sofie H.M.} and {van de Laar}, {Mart A.F.J.} and {Rongen-van Dartel}, {Sanne A.A.} and Reinhard Bos and Henk Visser and Brus, {Herman L.} and Tim Jansen and Vonkeman, {Harald E.} and {van Riel}, {Piet L.C.M.} and Wietske Kievit",

year = "2015",

month = oct,

day = "8",

doi = "10.1136/rmdopen-2015-000147",

language = "English",

volume = "1",

journal = "RMD Open",

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TY - JOUR

T1 - Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors

T2 - Data from the DREAM registry

AU - Manders, Sofie H.M.

AU - van de Laar, Mart A.F.J.

AU - Rongen-van Dartel, Sanne A.A.

AU - Bos, Reinhard

AU - Visser, Henk

AU - Brus, Herman L.

AU - Jansen, Tim

AU - Vonkeman, Harald E.

AU - van Riel, Piet L.C.M.

AU - Kievit, Wietske

PY - 2015/10/8

Y1 - 2015/10/8

N2 - Objectives: To study the number of patients that taper or discontinue concomitant methotrexate (MTX) in daily practice in patients with rheumatoid arthritis (RA) treated with tumour necrosis factor inhibitor (TNFi) and to analyse the effects of that adaption on disease activity and drug survival.Methods: Data were collected from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Patients who started their first TNFi were included in the study. Treatment effectiveness after MTX tapering or discontinuation was analysed using Disease Activity Score of 28 joints (DAS28). Drug survival of the TNFi was analysed using the Cox proportional hazard model with a time-dependent covariate.Results: In 458 patients (34%), MTX was tapered, 126 patients (10%) discontinued MTX and 747 patients (56%) continued MTX at the same dose. On average, DAS28 improved after tapering MTX (-0.40, -0.45) and after stopping MTX (-0.28, -0.12) at 6 and 12 months. In the taper group, 21% of the patients relapsed (DAS28 increase >0.6), and in the discontinuation group this was 21% and 24% at 6 and 12 months, respectively. Patients who taper and discontinue MTX have a similar DAS28 score over time as patients who continue MTX. Moreover, there was no influence of tapering or discontinuation of MTX on long-term drug survival of TNFi.Conclusions: In daily practice, tapering or discontinuation of concomitant MTX in patients with RA treated with TNFi frequently occurs and it does not seem to influence the average DAS28 over time or the long-term TNFi drug survival. It appears that in daily clinical practice the correct patients are selected to taper or discontinue MTX.

AB - Objectives: To study the number of patients that taper or discontinue concomitant methotrexate (MTX) in daily practice in patients with rheumatoid arthritis (RA) treated with tumour necrosis factor inhibitor (TNFi) and to analyse the effects of that adaption on disease activity and drug survival.Methods: Data were collected from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Patients who started their first TNFi were included in the study. Treatment effectiveness after MTX tapering or discontinuation was analysed using Disease Activity Score of 28 joints (DAS28). Drug survival of the TNFi was analysed using the Cox proportional hazard model with a time-dependent covariate.Results: In 458 patients (34%), MTX was tapered, 126 patients (10%) discontinued MTX and 747 patients (56%) continued MTX at the same dose. On average, DAS28 improved after tapering MTX (-0.40, -0.45) and after stopping MTX (-0.28, -0.12) at 6 and 12 months. In the taper group, 21% of the patients relapsed (DAS28 increase >0.6), and in the discontinuation group this was 21% and 24% at 6 and 12 months, respectively. Patients who taper and discontinue MTX have a similar DAS28 score over time as patients who continue MTX. Moreover, there was no influence of tapering or discontinuation of MTX on long-term drug survival of TNFi.Conclusions: In daily practice, tapering or discontinuation of concomitant MTX in patients with RA treated with TNFi frequently occurs and it does not seem to influence the average DAS28 over time or the long-term TNFi drug survival. It appears that in daily clinical practice the correct patients are selected to taper or discontinue MTX.

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U2 - 10.1136/rmdopen-2015-000147

DO - 10.1136/rmdopen-2015-000147

M3 - Article

AN - SCOPUS:85018193107

SN - 2056-5933

VL - 1

JO - RMD Open

JF - RMD Open

IS - 1

M1 - e000147

ER -

Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors: Data from the DREAM registry

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