Sustained benefits with methotrexate plus prednisone in RA
medwireNews: Adding prednisone to methotrexate treatment is associated with a persistent reduction in the rate of biologic treatment initiation and improvement in radiographic outcomes among patients with rheumatoid arthritis (RA), researchers report.
“In about one-third of patients with RA, [biologic] use does not result in sufficient clinical improvement,” explain Mary Safy (University Medical Center Utrecht, the Netherlands) and study co-authors.
“Therefore, it is important to optimise treatment strategies” based on conventional disease-modifying antirheumatic drugs before a biologic agent is added to the treatment regimen, they continue.
The team conducted a retrospective analysis of 218 participants of the CAMERA-II trial, in which patients were randomly assigned to initiate methotrexate treatment with either prednisone or placebo, followed by subsequent treatment steps including the addition of the biologic adalimumab depending on disease activity. After the 2-year trial ended, patients were treated at their rheumatologist’s discretion.
In all, 31% of 107 patients who were treated with methotrexate plus prednisone initiated biologic treatment over a median follow-up of 6.7 years, compared with 50% of 111 patients initially assigned to receive methotrexate plus placebo over a median follow-up of 6.6 years, a significant difference.
Participants in the methotrexate plus prednisone group also had significantly lower median erosion scores 2 years after the trial ended than those in the methotrexate plus placebo group, at 0 (interquartile range 0–0) versus 0 (interquartile range 0–2).
And a numerically greater proportion of patients receiving methotrexate plus prednisone were erosion-free at 2 years (83 vs 62%), although this difference did not reach statistical significance.
Furthermore, prednisone was “not clearly associated with increased incidence of long-term [glucocorticoid]-related comorbidities,” say Safy and team in the Annals of the Rheumatic Diseases.
Indeed, they found no significant difference in the incidence of glucocorticoid-related comorbidities between the treatment groups, although there were numerically higher cardiovascular comorbidity and mortality rates among patients in the methotrexate plus prednisone group (12 vs 7% and 9 vs 5%, respectively).
The researchers caution that the observed long-term outcomes “may have been influenced by the use of different antirheumatic drugs” after the trial period ended, and that there may have been bias in reporting comorbidities between the different groups.
“However, our study provides real-life data on daily clinical practice,” they say.
By Claire Barnard
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