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Research ArticleAccepted Article

Comparative persistence on methotrexate and TNF inhibitors in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis

Michael D. George, Joshua F. Baker and Alexis Ogdie
The Journal of Rheumatology September 2019, jrheum.190299; DOI: https://doi.org/10.3899/jrheum.190299
Michael D. George
From the University of Pennsylvania, Division of Rheumatology; Philadelphia Veterans Affairs Medical Center, Division of Rheumatology; University of Pennsylvania, Perelman School of Medicine, Department of Biostatistics Epidemiology and Informatics. Sources of support: This worked was supported by the McCabe Foundation; the Rheumatology Research Foundation Scientist Development Award to MG; the 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 United States Veterans Affairs Clinical Science Research & Development [grant number I01 CX001703 to JB]. Michael George: research grant from Bristol-Myers Squibb, consulting fees from AbbVie (<$10,000) Joshua Baker: consulting fees from Bristol-Myers Squibb and Corrona (<$10,000 each). Alexis Ogdie: consulting fees from Abbvie, Amgen, BMS, Celgene, Corrona, Lilly, Novartis, Pfizer, Takeda (<$10,000 each) and research grant funding to the University of Pennsylvania from Novartis and Pfizer. Address correspondence to Michael D. George, 5 White Building, 3400 Spruce St, Philadelphia, PA 19104. E-mail: Michael.george@uphs.upenn.edu
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Joshua F. Baker
From the University of Pennsylvania, Division of Rheumatology; Philadelphia Veterans Affairs Medical Center, Division of Rheumatology; University of Pennsylvania, Perelman School of Medicine, Department of Biostatistics Epidemiology and Informatics. Sources of support: This worked was supported by the McCabe Foundation; the Rheumatology Research Foundation Scientist Development Award to MG; the 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 United States Veterans Affairs Clinical Science Research & Development [grant number I01 CX001703 to JB]. Michael George: research grant from Bristol-Myers Squibb, consulting fees from AbbVie (<$10,000) Joshua Baker: consulting fees from Bristol-Myers Squibb and Corrona (<$10,000 each). Alexis Ogdie: consulting fees from Abbvie, Amgen, BMS, Celgene, Corrona, Lilly, Novartis, Pfizer, Takeda (<$10,000 each) and research grant funding to the University of Pennsylvania from Novartis and Pfizer. Address correspondence to Michael D. George, 5 White Building, 3400 Spruce St, Philadelphia, PA 19104. E-mail: Michael.george@uphs.upenn.edu
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Alexis Ogdie
From the University of Pennsylvania, Division of Rheumatology; Philadelphia Veterans Affairs Medical Center, Division of Rheumatology; University of Pennsylvania, Perelman School of Medicine, Department of Biostatistics Epidemiology and Informatics. Sources of support: This worked was supported by the McCabe Foundation; the Rheumatology Research Foundation Scientist Development Award to MG; the 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 United States Veterans Affairs Clinical Science Research & Development [grant number I01 CX001703 to JB]. Michael George: research grant from Bristol-Myers Squibb, consulting fees from AbbVie (<$10,000) Joshua Baker: consulting fees from Bristol-Myers Squibb and Corrona (<$10,000 each). Alexis Ogdie: consulting fees from Abbvie, Amgen, BMS, Celgene, Corrona, Lilly, Novartis, Pfizer, Takeda (<$10,000 each) and research grant funding to the University of Pennsylvania from Novartis and Pfizer. Address correspondence to Michael D. George, 5 White Building, 3400 Spruce St, Philadelphia, PA 19104. E-mail: Michael.george@uphs.upenn.edu
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Abstract

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.

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The Journal of Rheumatology
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1 Feb 2023
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Accepted manuscript
Comparative persistence on methotrexate and TNF inhibitors in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis
Michael D. George, Joshua F. Baker, Alexis Ogdie
The Journal of Rheumatology Sep 2019, jrheum.190299; DOI: 10.3899/jrheum.190299

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Accepted manuscript
Comparative persistence on methotrexate and TNF inhibitors in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis
Michael D. George, Joshua F. Baker, Alexis Ogdie
The Journal of Rheumatology Sep 2019, jrheum.190299; DOI: 10.3899/jrheum.190299
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