Methotrexate retention rate in patients with rheumatoid arthritis and psoriatic arthritis

Autores: Amanda Collere Melara, Vitor Itiro Ishisak, Thelma Larocca Skare, Ana Paula Beckhauser, Bárbara Stadler Kahlow

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Introduction: methotrexate (MTX) is a first-line therapy for rheumatoid arthritis (RA) and psoriatic arthritis (PsA). It is valued for its effectiveness, low cost, and ease of administration; however, side effects often lead to treatment discontinuation.

Objectives: to determine the causes of MTX discontinuation in patients with RA and PsA.

Materials and methods: a retrospective study was conducted including 148 patients (RA=102, PsA=46) who received MTX for at least one month before its withdrawal.

Results: the main reasons for discontinuing MTX in patients with RA and PsA were gastric intolerance: 71.5% (RA) vs. 45.6% (PsA) (p=0.002); hepatic toxicity: 4.9% (RA) vs. 17.3% (PsA) (p=0.02); and treatment failure: 8.8% (RA) vs. 15.2% (PsA) (p=0.24). The median duration of MTX use was 60 months in RA and 24 months in PsA (p<0.0001). Neither route of administration, body mass index, age, nor sex influenced treatment duration.

Conclusions: gastrointestinal intolerance was the main cause of MTX discontinuation, particularly in patients with RA. Hepatic toxicity was more frequent in PsA. Although MTX treatment lasted longer in RA, epidemiological and anthropometric factors were not associated with drug withdrawal.