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Effect of add-on methotrexate in polymyalgia rheumatica patients flaring on glucocorticoids tapering: a retrospective study

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Abstract

Guidelines on management of polymyalgia rheumatica (PMR) recommend early introduction of methotrexate (MTX), especially in patients with worse prognosis, although evidence on clinical efficacy of MTX in PMR is limited. Our objective was to assess MTX efficacy in real-world PMR care. Retrospective data of newly diagnosed PMR patients who started MTX were compared to control patients in whom MTX was not started at the first flare. Main outcomes were number of flares per year (Poisson regression) and weighted daily glucocorticoid (GC)-dose (linear regression), and flare incidence rate ratio in the MTX group only. 240 patients were selected; 39 patients in the MTX group and 201 in the control group. The yearly incidence rate ratio of flares in the MTX versus control group was 0.80 (95% CI 0.45–1.42). The yearly flare rate was 1.22 before and 0.43 after MTX initiation, resulting in an incidence ratio of 0.35 (95% CI 0.23–0.52). Adjusted time weighted daily GC dose was higher in the MTX versus control group (ratio 1.37, 95% CI 1.04–1.80). No clear effect of MTX on flares was found and time weighted daily GC dose was higher, possibly due to residual confounding by indication. However, the clearly reduced flare rate after MTX start might be suggestive for a beneficial effect of MTX.

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Acknowledgements

We would like to thank and acknowledge all the patients and colleagues that made this study possible. A special thank you to Else van Gerresheim, Remi Reurink, Vera de Graaf, Minka den Broeder, Beau de Korte, Michiel Minten, Lise Verhoef, Demi Donner and Arjen de Boer for their hard and dedicated work. This is an investigator driven study funded by the department of rheumatology at the Sint Maartenskliniek Nijmegen, The Netherlands. Part of this work was presented as poster at the conference meeting of the ACR and Dutch conference for rheumatology 2019.

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There was no external funding.

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Authors and Affiliations

  1. Department of Rheumatology, Sint Maartenskliniek, PO box 9011, 6500 GM, Nijmegen, The Netherlands

    Diane Marsman, Thomas Bolhuis, Nathan den Broeder, Frank van den Hoogen, Alfons den Broeder & Aatke van der Maas

  2. Department of Rheumatology, Radboudumc, Nijmegen, The Netherlands

    Frank van den Hoogen & Alfons den Broeder

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  1. Diane Marsman
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  2. Thomas Bolhuis
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  3. Nathan den Broeder
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  4. Frank van den Hoogen
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  5. Alfons den Broeder
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  6. Aatke van der Maas
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Each author contributed to this research and manuscript and fulfills all the criteria for authorship.

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Correspondence to Diane Marsman.

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None of the authors have conflicting interests in the context of this study.

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Marsman, D., Bolhuis, T., Broeder, N.d. et al. Effect of add-on methotrexate in polymyalgia rheumatica patients flaring on glucocorticoids tapering: a retrospective study. Rheumatol Int 41, 611–616 (2021). https://doi.org/10.1007/s00296-020-04783-2

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  • DOI: https://doi.org/10.1007/s00296-020-04783-2

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