Longterm methotrexate use in rheumatoid arthritis: 12 year followup of 460patients treated in community practice

Objective. To extend our observations on the longterm tolerability of metho trexate (MTX) and reasons for discontinuation in a cohort of 460 patients w ith rheumatoid arthritis (RA), Methods, We studied all patients with RA who started MTX before June 1986 a nd attended the community based private practices of 6 rheumatologists in M elbourne, information to at least April 1, 1995, or within one year of deat h was updated from the patient's medical records to include MTX discontinua tion and reasons for discontinuation. Addition of disease modifying antirhe umatic drugs (DMARD) concomitant with MTX was noted, Survival analyses base d upon life table methods were used with MTX discontinuation as the observa ble endpoint, Three different definitions of MTX discontinuation were used (1) according to whether the patient was taking the drug at last followup i rrespective of any periods of temporary discontinuation; (2) MTX discontinu ation for greater than or equal to 3 months considered to be a treatment en dpoint: and (3) addition of concomitant DMARD considered to be only partial success of MTX (as a need for additional therapy to meet treatment goals), Results, At 12 years, 53% of patients were continuing to take MTX (irrespec tive of any periods of temporary discontinuation). If discontinuation of th e drug for 3 or more months was considered a treatment termination then 38% were still taking the drug at 12 years, and if addition of concomitant DMA RD was regarded as a treatment endpoint only 17% of patients were continuin g MTX at 1? years, Withdrawal for gastrointestinal toxicity declined over t ime but the risk of other adverse effects appeared to persist over time, Conclusion. MTX in RA is well tolerated over the longer term, with > 50%; o f patients starting MTX in a community based rheumatology private practice continuing to take ii 12 years later, However, a substantial number of pati ents had 2nd line therapies added over this time, Monitoring for toxicity s hould continue throughout the course of therapy.