Inadequate response to treat-to-target methotrexate therapy in patients with new-onset rheumatoid arthritis: development and validation of clinical predictors

Annals of the Rheumatic Diseases
Xavier M TeitsmaJohannes W J Bijlsma

Abstract

To identify and validate clinical baseline predictors associated with inadequate response (IR) to methotrexate (MTX) therapy in newly diagnosed patients with rheumatoid arthritis (RA). In U-Act-Early, 108 disease-modifying antirheumatic drug (DMARD)-naive patients with RA were randomised to initiate MTX therapy and treated to target until sustained remission (disease activity score assessing 28 joints (DAS28) <2.6 with four or less swollen joints for ≥24 weeks) was achieved. If no remission, hydroxychloroquine was added to the treatment regimen (ie, 'MTX+') and replaced by tocilizumab if the target still was not reached thereafter. Regression analyses were performed to identify clinical predictors for IR, defined as needing addition of a biological DMARD, to 'MTX+'. Data from the treatment in the Rotterdam Early Arthritis Cohort were used for external validation of the prediction model. Within 1 year, 56/108 (52%) patients in U-Act-Early showed IR to 'MTX+'. DAS28 (adjusted OR (ORadj) 2.1, 95% CI 1.4 to 3.2), current smoking (ORadj 3.02, 95% CI 1.1 to 8.0) and alcohol consumption (ORadj 0.4, 95% CI 0.1 to 0.9) were identified as baseline predictors. The area under the receiver operator characteristic curve (AUROC) of the predic...Continue Reading

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Citations

Feb 19, 2020·Nature Reviews. Rheumatology·Bruce N Cronstein, Thomas M Aune
Apr 25, 2020·Nature Reviews. Rheumatology·Ernest H ChoyTadamitsu Kishimoto
Jul 3, 2020·Clinical Rheumatology·In-Woon BaekKi-Jo Kim
Oct 13, 2020·Intestinal research·Steven NicolaidesDaniel van Langenberg
Feb 3, 2021·The Journal of Rheumatology·Mary Safy-KhanUNKNOWN Society for Rheumatology Research Utrecht (SRU)
Jul 31, 2021·The Journal of Rheumatology·Gerrit JansenRobert de Jonge
Nov 19, 2021·Modern Rheumatology·Takahiko Sugihara

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