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Clinical Rheumatology

, Volume 38, Issue 3, pp 949–954 | Cite as

The effect of methotrexate versus other disease-modifying anti-rheumatic drugs on serum drug levels and clinical response in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors

  • Ana Martínez-FeitoEmail author
  • Chamaida Plasencia-Rodríguez
  • Victoria Navarro-Compán
  • Borja Hernández-Breijo
  • María Ángeles González
  • Irene Monjo
  • Laura Nuño
  • Pilar Nozal
  • Dora Pascual-Salcedo
  • Alejandro Balsa
Brief Report

Abstract

To investigate the effect of concomitant conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) with adalimumab or infliximab on maintaining serum drug and clinical outcomes after the first year of treatment in patients with rheumatoid arthritis (RA). Second, to assess the influence of methotrexate (MTX) dose on these outcomes. Ninety-two patients with RA starting infliximab (n = 67) or adalimumab (n = 25) tumor necrosis factor inhibitor (TNFi) with available drug levels and clinical improvement assessment (European League Against Rheumatism [EULAR] response) after 12 months were included. Patients were grouped according to concomitant csDMARD use: (i) TNFi monotherapy; (ii) TNFi+MTX; (iii) TNFi with csDMARDs other than MTX (TNFi+OD). Patients receiving MTX were also classified by dose as < 15 mg/week (TNFi+MTX<15) and ≥ 15 mg/week (TNFi+MTX≥15). Logistic regression analyses were employed. More TNFi+MTX patients had circulating serum TNFi at 12 months (71% TNFi+MTX vs. 20% TNFi+OD vs. 9% TNFi monotherapy). Of these, the probability of maintaining serum TNFi levels was twice (OR 2.3; p = 0.06) than that of patients without MTX. However, statistically significant results were observed only for the highest MTX dose (OR 4.9; p = 0.02). Most patients achieving good EULAR response were treated with TNFi+MTX (81%). The probability of achieving this response was three times higher in patients within the TNFi+MTX group (OR 3.4; p = 0.03); however, no differences were found with regard to MTX dose. The persistence of serum TNFi and the probability of achieving clinical response are influenced by MTX but not by OD in patients with RA treated with infliximab or adalimumab.

Keywords

csDMARDs EULAR response MTX dose Rheumatoid arthritis TNF inhibitors 

Notes

Acknowledgements

Chamaida Plasencia-Rodríguez has received speaking fees or funding for research projects from Pfizer, Lilly, Novartis, and Roche. Victoria Navarro-Compán has received speaking fees or funding for research projects and attending congresses from AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB; Dora Pascual-Salcedo has received speaking fees of Abbvie, Pfizer, Takeda, Menarini, and Grifols. Alejandro Balsa has received unrestricted grants from Pfizer, Roche, and AbbVie and speaker fees from Pfizer, Janssen, AbbVie, MSD, BMS, UCB, Nordic, Sandoz, and Roche.

Compliance with ethical standards

The study was approved by the La Paz University Hospital Ethics Committee and all the patients signed an informed consent document.

Disclosures

None

Supplementary material

10067_2018_4355_MOESM1_ESM.jpg (85 kb)
ESM 1 Flowchart of the study population.Description of study population according to the different concomitant use of csDMARDs at baseline.RA: rheumatoid arthritis; TNFi: TNF inhibitor; csDMARDs: conventional synthetic disease-modifying anti-rheumatic drugs; MTX:methotrexate; OD:other csDMARDs. (JPG 84 kb)

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Ana Martínez-Feito
    • 1
    • 2
    Email author
  • Chamaida Plasencia-Rodríguez
    • 1
    • 3
  • Victoria Navarro-Compán
    • 1
    • 3
  • Borja Hernández-Breijo
    • 1
  • María Ángeles González
    • 2
  • Irene Monjo
    • 3
  • Laura Nuño
    • 3
  • Pilar Nozal
    • 2
  • Dora Pascual-Salcedo
    • 1
  • Alejandro Balsa
    • 1
    • 3
  1. 1.Immuno-Rheumatology GroupHospital La Paz Institute for Health Research (IdiPAZ)MadridSpain
  2. 2.Immunology UnitUniversity Hospital La PazLa PazSpain
  3. 3.Rheumatology DepartmentUniversity Hospital La PazLa PazSpain

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