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Higher dose, earlier treatment with methotrexate benefits patients with PsA, data suggest

Monday, January 07 2008 | Comments

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What's This? Patients with psoriatic arthritis are being treated with higher doses of methotrexate earlier in the disease course than they were a decade or more ago, which has led to better outcomes, study authors reported.

The study included 59 patients who were treated with methotrexate for >=2 years at the University of Toronto's Psoriatic Arthritis Clinic between 1994 and 2004. The results for these patients were compared with those for 19 similar patients treated at the same clinic between 1978 and 1993.

The more recent cohort had an average disease duration of 8 years at baseline, compared with an average disease duration of 11.5 years at baseline for the earlier group. The patients in the recent group had a baseline average of 12.1 actively inflamed joints versus an average of 13.7 inflamed joints in the earlier cohort. The average radiographic damage score (assessed using a modified Steinbrocker method) was 5.1 in the later group and 8 in the earlier group (a higher score indicates progression of damage).

The mean weekly dose of methotrexate was 16.2 mg between 1994 and 2004 and 10.8 mg during the earlier period.

The primary outcome of the study was the increase in radiographic damage score. Two years after treatment initiation, the mean radiographic damage score had increased 1.5 points for the later group; the comparable increase for the earlier group was 2.3 points.

Among the more recent patients, 68% experienced a >=40% reduction in the number of actively inflamed joints, whereas 47% of the earlier patients had such a reduction.

The study authors noted that between-group differences in clinical response and radiographic progression fell short of statistical significance, primarily because of the small number of patients in the earlier period.

"There is now a need to reevaluate the proper role of methotrexate in psoriatic arthritis with regard to newer biologic agents, especially in early disease," the researchers concluded.

The study was published online Dec. 15 ahead of print in The Journal of Rheumatology by Chandran V. et al.

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