RT Journal Article SR Electronic T1 Comparative persistence on methotrexate and TNF inhibitors in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP jrheum.190299 DO 10.3899/jrheum.190299 A1 Michael D. George A1 Joshua F. Baker A1 Alexis Ogdie YR 2019 UL http://www.jrheum.org/content/early/2019/08/25/jrheum.190299.abstract AB Objective The role of methotrexate for the treatment of spondyloarthritis remains uncertain. Aims were to compare methotrexate and tumor necrosis factor inhibitor (TNFi) persistence in spondyloarthritis vs. RA and to determine whether concomitant conventional synthetic DMARD (csDMARD) use is associated with improved TNFi persistence in spondyloarthritis. Methods This retrospective cohort study using Optum's de-identified Clinformatics® Data Mart Database 2000-2014 identified patients with RA, psoriatic arthritis (PsA), and ankylosing spondylitis (SpA) without prior biologic use initiating methotrexate or a TNFi for the first time. Cox proportional hazards models compared time to medication discontinuation over the next two years between patients with RA, PsA, or AS, adjusting for potential confounders. In similar analyses stratified by disease, Cox models were used to assess whether concomitant use of csDMARDs was associated with TNFi persistence. Results We identified 31,527 methotrexate initiators (26,708 RA, 2,939 PsA, 1,880 AS) and 34,651 TNFi initiators (24,134 RA, 6,705 PsA, 3,812 AS). Methotrexate was discontinued sooner in patients with PsA [aHR 1.10 (1.04-1.16)] and AS [aHR 1.23 (1.16- 1.31)] vs. RA, while TNFi were discontinued at similar rates in RA and AS and discontinued later in PsA [aHR 0.93 (0.89-0.97)]. Concomitant use of methotrexate (compared to no csDMARD) was associated with lower rates of TNFi discontinuation in RA [aHR 0.85 (0.80-0.89)], PsA [aHR 0.81 (0.74-0.89)], and AS [aHR 0.79 (0.67-0.93]. Conclusion Methotrexate discontinuation occurs sooner in patients with PsA and AS vs. RA. Concomitant use of methotrexate with a TNFi, however, is associated with improved TNFi persistence in all three diseases.