Methotrexate and leflunomide survival in patients with psoriatic arthritis

Abstract

The objectives of this study were to estimate the survival rate of the most frequently used DMARDs in a cohort of PsA patients and factors associated with a higher survival rate. Methods: Patients ≥ 18 years of age with PsA according to CASPAR criteria, belonging to the RAPSODIA cohort were studied. Socio-demographic, clinical and treatment data were collected. Statistical analysis: Kaplan Meier survival curves and log rank were used to analyse and compare drugs' survival rate. Cox proportional analysis was performed to determine associated factors with drug survival. Results: 87 patients with PsA were included with a median age of 52 years (IQR 40.2-61.7) and a slight female predominance (52.9%). Seventy patients (80.5%) received MTX, 23 (32.9%) had to discontinue it due to adverse events (65%) or treatment failure (35%). The median survival time of MTX treatment was 13 years (IQR 8.5-17.4). The cumulative survival rate after 10 years of treatment was 55%, being significantly higher among patients receiving concomitant steroid therapy (median 16.4 ± 2.3 years vs. 10 ± 2 years, p=0.01). Of the 16 patients receiving LFN, 56.25% had to discontinue, estimating a median survival time of 6 years (IQR 1.6-10.3). The cumulative survival rate after 10 years was 35%. Using a cutoff value of 50 years, elderly patients had a higher drug survival (median 5.5 ± 1.5 years vs. 3 ± 1 years, p=0.03). Conclusion: MTX was the most frequently DMARD used. MTX cumulative survival was greater than that of LFN and was favoured by concomitant steroid therapy. LFN survival was higher amongst elderly patients.

Conventional Synthetic Disease-Modifying Anti-rheumatic Drugs for Psoriatic Arthritis: Findings and Implications From a Patient Centered Longitudinal Study in Brazil

“…Younger individuals had a higher discontinuation rate. This finding is similar to an Argentine cohort, which found that patients older than 50 years treated with leflunomide had a higher persistence to treatment ( Landi et al, 2018 ). This effect was also observed for methotrexate, but the patients treated with this drug were on steroids ( Ribeiro da Silva et al, 2019 ).…”

“…In this study, patients who were treated with leflunomide and methotrexate were the most persistent, while individuals taking ciclosporin and sulfasalazine showed a higher rate of discontinuation in the treatment of PsA. Methotrexate and leflunomide are usually the csDMARD investigated in observational studies for PsA, and the results are comparable between them ( Landi et al, 2018 ; Ribeiro da Silva et al, 2019 ). Sulfasalazine appeared only in one study versus methotrexate, with a worse result of persistence ( Jacobs et al, 2020 ).…”

“…Some studies have observed the performances of csDMARDs in the treatment of psoriatic arthritis ( Farr et al, 1988 ; Gupta, 1989 ; Farr et al, 1990 ; Combe et al, 1996 ; Fraser, 2005 ; Malesci et al, 2007 ; Ricci et al, 2011 ; Behrens et al, 2013 ; Nikiphorou et al, 2014 ; Landi et al, 2018 ; Ribeiro da Silva et al, 2019 ; Jacobs et al, 2020 ; Maksabedian Hernandez et al, 2020 ), among which five allow the comparison of drugs ( Malesci et al, 2007 ; Landi et al, 2018 ; Ribeiro da Silva et al, 2019 ; Jacobs et al, 2020 ; Maksabedian Hernandez et al, 2020 ), with increasing the relevance of these findings. In addition, one clinical trial has been conducted to assess methotrexate for PsA ( Mulder et al, 2020 ).…”

“…According to the findings, methotrexate was the most commonly used csDMARD, followed by leflunomide. Methotrexate had a higher cumulative survival rate than leflunomide and was aided by concomitant steroid therapy, whereas leflunomide had a higher survival rate in elderly patients ( Landi et al, 2018 ).…”

“…In summary, differences in medication persistence have been observed when comparing studies ( Landi et al, 2018 ; Ribeiro da Silva et al, 2019 ; Jacobs et al, 2020 ). This can be explained by differences concerning organization and access to health services, arising from regional inequities and methodological differences between studies.…”