-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
Yimaitong edited and sorted, please do not reprint
without authorization.
This is the first systematic review and meta-analysis study on the topic "Effect of MTX Reduction on RA Patients Treated with MTX Plus bDMARDs/tsDMARDs
".
The results suggest that reducing MTX in MTX plus bDMARDs/tsDMARDs in patients with RA after achieving remission is only 10% less likely to have sustained remission than no reduction
.
Based on this, the investigators believe that the study supports the strategy
recommended by the ACR guidelines to reduce MTX from combination therapy.
It is also prudent to recommend continued use of MTX
if the patient can tolerate it.
Once confirmed in patients with
.
Methotrexate (MTX) alone is recommended
.
Clinically, tapering the drug until complete discontinuation is an ideal goal for many patients with chronic disease, including in RA
.
Patients want to reduce adverse effects while maintaining good disease control
.
The RA guidelines issued by the 2021 ACR indicate that patients receiving MTX in combination with bDMARDs/tsDMARDs who wish to discontinue DMARDs can gradually discontinue MTX
.
However, due to insufficient evidence, it is only conditionally recommended
.
In this context, Dr.
Meng and his collaborators of Cornell University conducted the first systematic literature review to evaluate whether MTX can be sustained in patients with RA who achieve remission with MTX plus bDMARDs/tsDMARDs
.
The results of the study were recently published in the journal J Rheumatol.
(impact factor 5.
346).
Research methods
Studies searched Medline, Embase, and Cochrane databases for relevant literature from 1 January 2014 to 30 August 2021 for prospective comparative studies to understand the ongoing outcome of remission after reduction in MTX from RA treatment, including bDMARDs
.
A random-effects model was used for meta-analysis to create forest and funnel plots
.
Study results
We were selected for 10 studies, nine randomised studies, and one observational study
.
Three of the 10 studies included early RA (disease duration < one year).
Randomized studies were followed for 3 to 18 months, and observational studies were followed for 3 years
.
A meta-analysis of 2000 RA patients from 10 studies showed that patients treated with bDMARDs/tsDMARDs who gradually reduced MTX had a 10% reduced ability to maintain remission compared with unreduced patients, with a combined hazard ratio (RR) of 0.
90 (95% confidence interval [CI] 0.
84, 0.
97, Figure 1), and no heterogeneity (I2=0.
0%, p=0.
938).
Figure 1 Meta-analysis of the effects of MTX reduction
In the studies including only early RA, the ability to maintain remission was also reduced, with an RR of 0.
84 (0.
73 to 0.
98) and no heterogeneity (I2=0.
0%, p=0.
392).
In the trials including patients with confirmed RA, RR was 0.
92 (0.
85 to 1.
01) with no heterogeneity (I2=0.
0%, p=0.
996).
A separate meta-analysis of the risk of maintaining low disease activity after MTX reduction found results similar to those reported above (RR 0.
92 [CI 0.
86 to 0.
98]).
The funnel plot showed less
bias.
Conclusion of the study
This is the first systematic review and meta-analysis study
on the topic "Effects of MTX Reduction in RA Patients Treated with MTX Plus bDMARDs/tsDMARDs".
The results showed that MTX reduction in RA patients after achieving remission was reduced by only 10%
in their ability to maintain remission.
This review adds to the evidence
recommended by the ACR guidelines for tapering methotrexate from combination therapy.
It also supports strategies
to discontinue MTX in women of childbearing age who have achieved remission, have MTX-related adverse effects (e.
g.
, alopecia, stomatitis, nausea,
Finally, the investigators caution suggest that it is recommended to continue methotrexate combination therapy when well tolerated, as the long-term effects of drug reduction require further study, and in some studies there are indicators
of potential deterioration of prognosis after drug reduction.
References: Meng CF, Rajesh DA, Jannat-Khah DP, et al.
Can Patients with Controlled Rheumatoid
J Rheumatol.
2022 Aug 15:jrheum.
220152.
doi: 10.
3899/jrheum.
220152.
Epub ahead of print.
PMID: 35970524.
