Treatment of rheumatoid arthritis with methotrexate alone and in combination with other conventional DMARDs using the T2T strategy. A cohort study

Santos-Moreno, P.; Hoz-Valle, José De la; Villarreal, L.; Palomino, A.; Sánchez, Guillermo; Castro, Carlos A.

doi:10.1007/s10067-014-2794-9

Cited by 20 publications

(16 citation statements)

References 26 publications

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Section: Discussionsupporting

confidence: 85%

“…The socio-demographic characteristics of average age and sex of the cohort are similar to those reported by other authors in general (9)(10)(11). However, the percentage of patients who entered clinical remission measured with a strategy to improve the DAS28 was 42.9%, which is a greater percentage than that obtained in other studies made in Brazil (13.6%) and Israel (26.7%) which had a lower number of cases (9,10), but inferior to the reported percentage in previous studies carried out in Colombia (11,12). It is relevant as well to observe how the proportion of patients with low RA activity improved and how the quantity of patients with high activity diminished to 9.8%, a significantly lower proportion than reported in Brazil (over 17%) and Israel (20%), respectively (9,10), showing the proper response to therapy not just in remission and low activity levels but in a lower proportion of patients with high activity in cohorts with similar characteristics.…”

Section: Discussionsupporting

confidence: 85%

“…A possible explanation for these findings could be related to the high proportion of patients that received biological DMARDs which came to be used in more than a quarter of the population at the end of the observation period, which differs from the Brazilian and Colombian cohorts mentioned previously in which these were not used (9,11). It should be noted that these drugs have demonstrated excellent effectiveness in a wide range of patients, including those classed as difficult to control (13)(14)(15), despite being costly for any healthcare system (16,17) and exhibiting a high incidence of adverse events (4).…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of treatment with biologic- and disease-modifying antirheumatic drugs in rheumatoid arthritis patients in Colombia

Machado‐Alba

Ruiz²,

Machado‐Duque

2016

Int J Clin Pract

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Summary Aims Rheumatoid arthritis (RA) is an autoimmune disease cause of disability and high costs. To determine the effectiveness of therapy with biologic‐ and disease‐modifying antirheumatic drugs (DMARDs) in patients with RA and factors associated with the control of the disease. Methods Retrospective cohort study of RA patients receiving treatment with DMARDs in a rheumatologic healthcare institution in five Colombian cities from December 2009 to August 2013. The effectiveness was assessed by Disease Activity Score‐28 (DAS‐28) and a lower value of 2.6 was considered remission. Results A total of 827 patients were studied for an average observation period of 17.3 ± 11.0 months, with mean age 54.3 ± 13.1 years. The most frequently used DMARDs were methotrexate, leflunomide and chloroquine. The most frequently used biological DMARDs were etanercept and abatacept. Initially, 17.8% of the patients received some biological DMARDs in comparison with 28.7% at the end of the observation period. A median DAS28 of 3.5 was found, which was reduced by the end of the observation period to 2.8 (p < 0.001), and cases of patients who were in remission increased from 30.1% to 42.9%. Treatment with leflunomide (OR: 0.47; CI 95%: 0.35–0.64, p < 0.001) or rituximab (OR: 0.37; CI 95%: 0.17–0.83, p = 0.016) was associated with a lesser probability of reaching remission. To be treated in the city of Manizales (OR: 2.56; CI 95%: 1.36–4.82, p = 0.004) was associated with a high probability of remission. Conclusions Biological and DMARDs therapy for RA was effective in a relevant proportion of Colombian patients as a consequence of management with strategies set on remission aims quantified using DAS28. Cost‐effectiveness of the therapy must be evaluated.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Effectiveness of treatment with biologic- and disease-modifying antirheumatic drugs in rheumatoid arthritis patients in Colombia

Machado‐Alba

Ruiz²,

Machado‐Duque

2016

Int J Clin Pract

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“…During the Swedish Pharmacotherapy trial run‐in period, mean DAS28 decreased by 1.2 among 258 subjects after 3–4 months of methotrexate. In a cohort of 307 longstanding RA patients with moderate to high disease activity treated with methotrexate (without bDMARDs), mean DAS28 decreased by 1.6 after 6 months . Our observed difference of 0.49 between the highest and lowest categories of fish consumption is approximately one‐third the magnitude of these observed differences in DAS28 among methotrexate users.…”

Section: Discussionmentioning

confidence: 59%

Relationship Between Fish Consumption and Disease Activity in Rheumatoid Arthritis

Tedeschi

Bathon

Giles

et al. 2018

Arthritis Care & Research

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“…Early diagnosis and treatment play a key role in the evolution of the disease [21]. Although the ACR20 response in patients with early RA and failure to monotherapy with MTX initiating Step-Up with LEF, is approximately 60%, there is a lack of evidence of the percentage of patients achieving remission by DAS28 with this combination [3,17].…”

Section: Introductionmentioning

confidence: 99%

Metothrexate Plus Leflunomide Step-Up Therapy in Early Rheumatoid Arthritis Patients with Non-Response to Initial Methotrexate Monotherapy

Carlevaris¹,

Citera²,

Pellet³

et al. 2019

Rheumatology

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Methods: We included a cohort of patients with diagnosis of early RA of less than 2 years of disease duration who not respond to MTX monotherapy, according to medical judgment, and added step-up combination with LEF. Data were collected every 3 months, including sociodemographic characteristics, functional status, disease activity and treatment. The primary outcome was the time to remission with the combined therapy, defined according to disease activity index of 28 joints (DAS28). Combination treatment failure was defined as not achieving remission. Time of outcome was assessed from date of the start of MTX plus LEF combination to date of remission or last follow-up. The Kaplan-Meier product limit method was used to estimate the probability of each outcome. Results: A total of 106 patients were included. The median disease duration was 4 (IQR 2-8) months. Median followup was 34 ± 18 months (300 patients-year). Mean age was 50 ± 12 years and 83% were female. At the time of LEF addition, 95 (90%) of patients were not in remission. During follow-up, 47 (50%) achieved clinical remission at a median time of 8 months. The rest of the patients failed to achieve remission. The overall probability of remission per patients-months of follow-up was 0.49. Twenty seven out of 47 patients (58%) were still in remission at the last follow up visit (median follow-up after first remission=19 months).

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Treatment of rheumatoid arthritis with methotrexate alone and in combination with other conventional DMARDs using the T2T strategy. A cohort study

Cited by 20 publications

References 26 publications

Effectiveness of treatment with biologic- and disease-modifying antirheumatic drugs in rheumatoid arthritis patients in Colombia

Effectiveness of treatment with biologic- and disease-modifying antirheumatic drugs in rheumatoid arthritis patients in Colombia

Relationship Between Fish Consumption and Disease Activity in Rheumatoid Arthritis

Metothrexate Plus Leflunomide Step-Up Therapy in Early Rheumatoid Arthritis Patients with Non-Response to Initial Methotrexate Monotherapy

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