Impact of Methotrexate Withdrawal on Successfully Treated Rheumatoid Arthritis

Researchers evaluated the effect of methotrexate withdrawal on disease activity and remission in patients with rheumatoid arthritis. In their study, published, Rheumatology, they reported that methotrexate withdrawal slightly increased rheumatoid arthritis disease activity in patients who were at treatment target after therapy with biologic disease-modifying antirheumatic drugs (bDMARDs) or targeted synthetic (ts)DMARDs plus methotrexate.

This meta-analysis included 6 randomized controlled trials with 1,430 total patients published to the PubMed, EMBASE, and CENTRAL databases by March 7, 2022. The primary end points of the study included change in DAS28 after methotrexate withdrawal, low disease activity, proportion of remission, SDAI, CDAI or boolean remission. Cochrane Q and I2 tests were used to assess the quality of included articles.

Methotrexate Withdrawal Lightly Impacts Rheumatoid Arthritis at Treatment Target

According to the authors’ analysis, tapering or discontinuing methotrexate increased DAS28 by 0.20 (95% CI, 0.09-0.32; I2=0%) compared to continuing combination therapy. Additionally, methotrexate withdrawal decreased the proportion of patients with low disease activity to <3.2 (risk ratio [RR], 0.88; 95% CI, 0.80-0.97; I2=0%).

However, the researchers noted that withdrawal did not decrease the rate of remission (RR, 0.90; 95% CI, 0.81-1.01), SDAI (RR, 0.93; 95% CI, 0.77-1.11), CDAI (RR, 0.90; 95% CI, 0.75-1.11), or boolean remission (RR, 0.95; 95% CI, 0.70-1.29).

Ultimately, the researchers summarized that methotrexate withdrawal slightly increased rheumatoid arthrtiits disease activity in patients who reached a treatment target with combination therapy including bDMARDS or tsDMARDS and methotrexate. THey also noted that withdrawal had “limited effects” on patients in deep remission.

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