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Research ArticleRheumatoid Arthritis

Comparative Persistence of Methotrexate and Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis

Michael D. George, Joshua F. Baker and Alexis Ogdie
The Journal of Rheumatology June 2020, 47 (6) 826-834; DOI: https://doi.org/10.3899/jrheum.190299
Michael D. George
From the University of Pennsylvania, Division of Rheumatology, and Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics; Philadelphia Veterans Affairs Medical Center, Division of Rheumatology, Philadelphia, Pennsylvania, USA.
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  • For correspondence: Michael.george@uphs.upenn.edu
Joshua F. Baker
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Alexis Ogdie
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Abstract

Objective. The role of methotrexate (MTX) for the treatment of spondyloarthritis (SpA) remains uncertain. Aims were to compare MTX and tumor necrosis factor inhibitor (TNFi) persistence in spondyloarthritis versus rheumatoid arthritis (RA) and to determine whether concomitant conventional synthetic disease-modifying antirheumatic drug (csDMARD) use is associated with improved TNFi persistence in SpA.

Methods. This retrospective cohort study using Optum’s deidentified Clinformatics Data Mart Database 2000–2014 identified patients with RA, psoriatic arthritis (PsA), and ankylosing spondylitis (AS) without prior biologic use who were initiating MTX or a TNFi. Cox proportional hazards models compared time to medication discontinuation over the next 2 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 csDMARD was associated with TNFi persistence.

Results. We identified 31,527 MTX initiators (26,708 RA, 2939 PsA, 1880 AS) and 34,651 TNFi initiators (24,134 RA, 6705 PsA, 3812 AS). MTX was discontinued sooner in patients with PsA [adjusted HR (aHR) 1.10, 95% CI 1.04–1.16] and AS (aHR 1.23, 1.16–1.31) versus 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 MTX (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. MTX discontinuation occurs sooner in patients with PsA and AS versus RA. Concomitant use of MTX with a TNFi, however, is associated with improved TNFi persistence in all 3 diseases.

Key Indexing Terms:
  • SPONDYLOARTHRITIS
  • PSORIATIC ARTHRITIS
  • RHEUMATOID ARTHRITIS
  • ANTIRHEUMATIC DRUGS
  • TUMOR NECROSIS FACTOR INHIBITORS
  • METHOTREXATE

Footnotes

  • This work was supported by the McCabe Foundation; the Rheumatology Research Foundation Scientist Development Award to MG; the US National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health (grant numbers K23 AR073931-01 to MG and R01 AR072363 to AO); and the US Veterans Affairs Clinical Science Research and Development (grant number I01 CX001703 to JB). Dr. Ogdie has received research grant funding to the University of Pennsylvania from Novartis and Pfizer.

  • Accepted for publication August 22, 2019.
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The Journal of Rheumatology
Vol. 47, Issue 6
1 Jun 2020
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Comparative Persistence of Methotrexate and Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis
Michael D. George, Joshua F. Baker, Alexis Ogdie
The Journal of Rheumatology Jun 2020, 47 (6) 826-834; DOI: 10.3899/jrheum.190299

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Comparative Persistence of Methotrexate and Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis
Michael D. George, Joshua F. Baker, Alexis Ogdie
The Journal of Rheumatology Jun 2020, 47 (6) 826-834; DOI: 10.3899/jrheum.190299
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Keywords

SPONDYLOARTHRITIS
PSORIATIC ARTHRITIS
RHEUMATOID ARTHRITIS
ANTIRHEUMATIC DRUGS
TUMOR NECROSIS FACTOR INHIBITORS
METHOTREXATE

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Keywords

  • spondyloarthritis
  • psoriatic arthritis
  • rheumatoid arthritis
  • ANTIRHEUMATIC DRUGS
  • TUMOR NECROSIS FACTOR INHIBITORS
  • methotrexate

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