Non-adherence and discontinuation rate for oral and parenteral methotrexate: A retrospective-cohort study in 8,952 patients with psoriatic arthritis.
Adherence
HCQ, hydroxychloroquine
HR, Hazard ratio
IQR, inter-quartile range
LEF, leflunomide
MTX, methotrexate
Methotrexate
NSAIDs, non-steroidal anti-inflammatory drugs
OGC, oral glucocorticoids
Oral
Parenteral
PsA, psoriatic arthritis
PsO, psoriasis
Psoriatic arthritis
Retention rate
SSZ, sulfasalazine
TNF, tumor necrosis factor alpha
list: csDMARDs, conventional synthetic disease modifying anti-rheumatic drugs
Journal
Journal of translational autoimmunity
ISSN: 2589-9090
Titre abrégé: J Transl Autoimmun
Pays: Netherlands
ID NLM: 101759413
Informations de publication
Date de publication:
2021
2021
Historique:
received:
11
08
2021
accepted:
14
08
2021
entrez:
10
1
2022
pubmed:
11
1
2022
medline:
11
1
2022
Statut:
epublish
Résumé
Treatment options for PsA, following non-steroidal anti-inflammatory drugs (NSAIDs), include conventional synthetic disease modifying anti-rheumatic drugs (csDMARDS), particularly methotrexate (MTX). The present study was performed to determine the non-adherence and discontinuation rates of different methotrexate (MTX) formulations in psoriatic arthritis (PsA). We performed a retrospective-cohort study on patients with PsA identified by disease-specific code in the administrative-health-databases of a Northern Italian region (Lombardy) between 2004 and 2015. Subjects were defined as non-adherent if less than 80% of the prescribed MTX dose was taken based on the time between each prescription. Discontinuation rates were calculated using the time between the first and the last MTX prescription over an observation period of 120 months. Among 8952 patients with PsA, 33% were treated with MTX (mean dosage 10 mg/week ± 2.5 mg standard deviation), more frequently (59%) in its parenteral formulation at a 10 mg weekly dosage (35%). Oral glucocorticoids were prescribed to 21% of patients, while non-steroidal anti-inflammatory drugs to 45%. Approximately 37% of patients with PsA were defined as non-adherent to MTX, with the oral formulation associated with an increased risk of non-adherence (hazard ratio 2.08, 95% confidence interval 1.84-2.35, p < 0.001) compared with parenteral 10-15 mg weekly doses. Oral MTX was discontinued in 52% of cases without a significantly increased risk of discontinuation compared to parenteral formulations which, at higher dosages, had a more favorable retention rate. Oral MTX formulation is associated with a 2-fold risk of non-adherence compared to MTX parenteral route in PsA.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Treatment options for PsA, following non-steroidal anti-inflammatory drugs (NSAIDs), include conventional synthetic disease modifying anti-rheumatic drugs (csDMARDS), particularly methotrexate (MTX). The present study was performed to determine the non-adherence and discontinuation rates of different methotrexate (MTX) formulations in psoriatic arthritis (PsA).
APPROACH AND RESULTS
RESULTS
We performed a retrospective-cohort study on patients with PsA identified by disease-specific code in the administrative-health-databases of a Northern Italian region (Lombardy) between 2004 and 2015. Subjects were defined as non-adherent if less than 80% of the prescribed MTX dose was taken based on the time between each prescription. Discontinuation rates were calculated using the time between the first and the last MTX prescription over an observation period of 120 months. Among 8952 patients with PsA, 33% were treated with MTX (mean dosage 10 mg/week ± 2.5 mg standard deviation), more frequently (59%) in its parenteral formulation at a 10 mg weekly dosage (35%). Oral glucocorticoids were prescribed to 21% of patients, while non-steroidal anti-inflammatory drugs to 45%. Approximately 37% of patients with PsA were defined as non-adherent to MTX, with the oral formulation associated with an increased risk of non-adherence (hazard ratio 2.08, 95% confidence interval 1.84-2.35, p < 0.001) compared with parenteral 10-15 mg weekly doses. Oral MTX was discontinued in 52% of cases without a significantly increased risk of discontinuation compared to parenteral formulations which, at higher dosages, had a more favorable retention rate.
CONCLUSION
CONCLUSIONS
Oral MTX formulation is associated with a 2-fold risk of non-adherence compared to MTX parenteral route in PsA.
Identifiants
pubmed: 35005587
doi: 10.1016/j.jtauto.2021.100113
pii: S2589-9090(21)00033-2
pmc: PMC8716656
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100113Informations de copyright
© 2021 The Authors.
Déclaration de conflit d'intérêts
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Références
Clin Rheumatol. 2014 May;33(5):609-14
pubmed: 24609758
Ann Rheum Dis. 2010 Apr;69(4):671-6
pubmed: 19740904
J Rheumatol. 2016 Nov;43(11):1997-2009
pubmed: 27803341
J Rheumatol. 2016 Feb;43(2):356-61
pubmed: 26669913
Mod Rheumatol. 2013 May;23(3):525-8
pubmed: 22752502
Br J Dermatol. 2019 Jan;180(1):100-107
pubmed: 29947129
Arthritis Rheumatol. 2016 May;68(5):1060-71
pubmed: 26749174
J Rheumatol Suppl. 2020 Jun;96:31-35
pubmed: 32482765
Lancet. 2015 Dec 19;386(10012):2489-98
pubmed: 26433318
Rheumatol Int. 2017 Feb;37(2):213-218
pubmed: 28012023
Rheumatology (Oxford). 2021 Feb 1;60(2):780-784
pubmed: 32797218
Ann Rheum Dis. 2020 Jun;79(6):700-712
pubmed: 32434812
Ther Adv Musculoskelet Dis. 2012 Feb;4(1):3-9
pubmed: 22870490
Arthritis Rheumatol. 2016 Sep;68(9):2141-50
pubmed: 27015429
Int J Rheum Dis. 2019 Aug;22(8):1498-1505
pubmed: 31134727
Autoimmun Rev. 2007 Sep;6(8):511-4
pubmed: 17854740
JAMA Dermatol. 2013 Oct;149(10):1180-5
pubmed: 23945732
Ann Rheum Dis. 2004 Nov;63 Suppl 2:ii13-ii17
pubmed: 15479864
Arthritis Care Res (Hoboken). 2017 Jun;69(6):867-874
pubmed: 27696735
Autoimmun Rev. 2009 Jan;8(3):274-80
pubmed: 19017546
BMC Rheumatol. 2018 Sep 29;2:29
pubmed: 30886979
Ann Rheum Dis. 2018 Feb;77(2):175-187
pubmed: 28765121
Rheumatol Int. 2016 May;36(5):627-33
pubmed: 26936262
Rheumatology (Oxford). 2012 Aug;51(8):1368-77
pubmed: 22344575
Ann Rheum Dis. 2015 Jun;74(6):1045-50
pubmed: 24525911
Ann Rheum Dis. 2016 Mar;75(3):499-510
pubmed: 26644232
N Engl J Med. 2005 Aug 4;353(5):487-97
pubmed: 16079372