PMID- 29166919
OWN - NLM
STAT- MEDLINE
DCOM- 20180709
LR  - 20181113
IS  - 1478-6362 (Electronic)
IS  - 1478-6354 (Linking)
VI  - 19
IP  - 1
DP  - 2017 Nov 22
TI  - Similar short-term clinical response to high-dose versus low-dose methotrexate in
      monotherapy and combination therapy in patients with rheumatoid arthritis.
PG  - 258
LID - 10.1186/s13075-017-1468-9 [doi]
AB  - BACKGROUND: Aiming at rapid decrease of disease activity, there has been a trend 
      to start with higher doses of methotrexate (MTX) in patients newly diagnosed with
      rheumatoid arthritis (RA), both as monotherapy and in combination with other
      antirheumatic drugs. We aimed to study the relationship between clinical response
      and MTX dose as monotherapy or combination therapy in patients with early RA.
      METHODS: Disease-modifying anti-rheumatic drug (DMARD)-naive patients with early 
      RA, from a large international observational database, the METEOR database, were 
      selected if MTX was part of their initial treatment. Patients were divided into
      four groups: MTX monotherapy, MTX + convention synthetic (cs)DMARDs, MTX +
      glucocorticoids or MTX + biologic (b)DMARDs. MTX dose was dichotomized: low dose 
      </=10 mg/week; high dose >/=15 mg/week. Linear mixed model analyses for the
      Disease Activity Score (DAS), DAS in 28 joints (DAS28) and Health Assessment
      Questionnaire (HAQ) were performed in each medication group, with MTX dose and
      time as covariates. Outcomes were assessed from baseline until 3-6 months follow 
      up. Associations were adjusted for potential confounding by indication using
      propensity score (PS) modelling. RESULTS: For patients starting MTX monotherapy
      (n = 523), MTX + csDMARDs (n = 266) or MTX + glucocorticoids (n = 615), the
      PS-adjusted effects of MTX dose (high versus low) on the DAS, DAS28 and HAQ were 
      small and not clinically meaningful. Patients starting MTX + bDMARDs were
      disregarded due to low numbers (n =11). CONCLUSIONS: In patients newly diagnosed 
      with RA, no clinical benefit of high compared to low initial MTX doses was found 
      for MTX monotherapy or for MTX combination therapy with csDMARDs or
      glucocorticoids.
FAU - Bergstra, Sytske Anne
AU  - Bergstra SA
AUID- ORCID: http://orcid.org/0000-0002-7136-5248
AD  - Department of Rheumatology, Leiden University Medical Centre, Leiden, The
      Netherlands. s.a.bergstra@lumc.nl.
FAU - Allaart, Cornelia F
AU  - Allaart CF
AD  - Department of Rheumatology, Leiden University Medical Centre, Leiden, The
      Netherlands.
FAU - van den Berg, Rosaline
AU  - van den Berg R
AD  - Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The
      Netherlands.
FAU - Chopra, Arvind
AU  - Chopra A
AD  - Center for Rheumatic Diseases, Pune, India.
FAU - Govind, Nimmisha
AU  - Govind N
AD  - University of the Witwatersrand, Johannesburg, South Africa.
FAU - Huizinga, Tom W J
AU  - Huizinga TWJ
AD  - Department of Rheumatology, Leiden University Medical Centre, Leiden, The
      Netherlands.
FAU - Landewe, Robert B M
AU  - Landewe RBM
AD  - Amsterdam Rheumatology & Immunology Center, Amsterdam, The Netherlands.
AD  - Zuyderland Medical Center, Heerlen, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20171122
PL  - England
TA  - Arthritis Res Ther
JT  - Arthritis research & therapy
JID - 101154438
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Biological Products)
RN  - 0 (Glucocorticoids)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
MH  - Adult
MH  - Antirheumatic Agents/therapeutic use
MH  - Arthritis, Rheumatoid/*drug therapy/pathology
MH  - Biological Products/*therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Drug Therapy, Combination
MH  - Female
MH  - Glucocorticoids/*therapeutic use
MH  - Humans
MH  - Linear Models
MH  - Male
MH  - Methotrexate/*therapeutic use
MH  - Middle Aged
MH  - Propensity Score
MH  - Surveys and Questionnaires
MH  - Treatment Outcome
PMC - PMC5700534
OTO - NOTNLM
OT  - Combination therapy
OT  - Dose
OT  - Methotrexate
OT  - Outcome measures
OT  - Rheumatoid arthritis
EDAT- 2017/11/24 06:00
MHDA- 2018/07/10 06:00
CRDT- 2017/11/24 06:00
PHST- 2017/06/26 00:00 [received]
PHST- 2017/11/07 00:00 [accepted]
PHST- 2017/11/24 06:00 [entrez]
PHST- 2017/11/24 06:00 [pubmed]
PHST- 2018/07/10 06:00 [medline]
AID - 10.1186/s13075-017-1468-9 [doi]
AID - 10.1186/s13075-017-1468-9 [pii]
PST - epublish
SO  - Arthritis Res Ther. 2017 Nov 22;19(1):258. doi: 10.1186/s13075-017-1468-9.