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Patients who have taken these drugs in combination may not be so afraid to stop methotrexate...

 Last Update: 2022-10-20
 Source: Internet
 Author: User

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▎Clinical issues: Acceptance of biologic DMARDs (bDMARDs)/targeted synthesis What is the effect of stopping MTX in patients treated with DMARDs (tsDMARDs) plus MTX on disease activity and response rates? Literature screenshot

▎ Research protocol:

Multiple databases searched for all randomised controlled trials (RCTs) of discontinuation of MTX after combination of targeted therapy in people with rheumatoid arthritis (RA) from initiation to 7 March 2022, including six RCTs of non-inferiority studies involving 1430 patients (734 in the discontinuation group and 696 in the continuation group);

The extracted data included: change in DAS28 score due to discontinuation at the endpoint; proportion of low disease activity (LDA) assessed by DAS28, SDAI, or CDAI; proportion of response assessed by DAS28, SDAI, CDAI, or ACR/EULAR Boolean mitigation;

Cochrane Q and I2 tests were used to assess heterogeneity, and random-effects models were used for data synthesis.

▎Key findings:

Tapering or discontinuing MTX increased DAS28 by 0.
20 (95% CI 0.
09~0.
32, I2 = 0%) compared with continuing combination therapy and reduced the percentage of LDA patients assessed by DAS28 to <3.
2 [RR 0.
88 (0.
80, 0.
97), I2 = 0%];

Discontinuation of MTX did not reduce response rates assessed by DAS28, SDAI, CDAI, or ACR/EULAR Boolean [RR 0.
90 (0.
81, 1.
01), 0.
93 (0.
77, 1.
11), 0.
90 (0.
74, 1.
11), 0.
95 (0.
70, 1.
29),
respectively.

▎Conclusion and prospect: The results of this study show that patients treated with bDMARDs/tsDMARDs combined with MTX can reduce or stop MTX , with little effect on disease activity; If tolerated by the patient, continued use of MTX
is recommended.

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