Ab0473 the efficacy of methotrexate monotherapy strategy chosen as first-line dmard therapy in patients with newly diagnosed rheumatoid arthritis: retrospective evaluation of single tertiary center experience

Background Rheumatoid Arthritis (RA) is a chronic systemic disease in which immunologically mediated inflammation of synovia-lined joints can disrupt joint structure and function. Methotrexate is the first recommended conventional disease-modifying antirheumatic drugs (DMARD) when diagnosed in patients with RA. The goal of treatment is low disease activity or remission [1]. Objectives It was aimed to retrospectively evaluate the response of patients who received methotrexate (MTX) monotherapy as a first-line DMARD strategy in newly diagnosed RA patients. Methods Between January 2018-September 2022, 642 patients diagnosed with RA in the Department of Internal Medicine Rheumatology of Sakarya University were retrospectively analyzed. All patients fulfilled the criteria for the 2010 Rheumatoid arthritis classification. Patients with newly diagnosed RA and obtaining MTX monotherapy as the first conventional DMARD strategy were included in the study. Patients diagnosed in another center and initially started conventional DMARD combination therapy were excluded from the study. Patients who discontinued treatment due to side effects were excluded and 73 were included in the study. Age, gender, rheumatoid factor and anticitrulized peptide antibody levels of the patients were recorded. Disease activity was evaluated at 0-3-6 months with the Disease Activity Score Calculator for Rheumatoid Arthritis (DAS-28). Data were analyzed using the computer program SPSS 21. Wilcoxon Signed Rank test and Friedman test were used from non-parametric tests. p<0.05 was considered statistically significant. Results The mean age of the patients was 54.82±11.65 years. Before MTX treatment, 27 (37.0%) patients had moderate DAS-28 scores and 46 (63.0%) patients had high disease activity. In the third months after MTX treatment, 44 (60.3%) patients were in remission or low disease activity, and 29 (39.7%) patients were moderate or high disease activity. In the sixth months after MTX treatment, 61 (83.6%) patients were in remission or low disease activity, and 12 (16.4%) patients were moderate or high disease activity (Table 1). The median DAS-28 score of the patients before MTX treatment was 5.51 (min-max: 3.49-7.77), the median score of the third months after treatment was 2.86 (min-max: 0.77-5.63) and the sixth months after treatment was 2.33 (min-max: 0.77-5.24). A significant improvement was observed in the DAS-28 score evaluated during the treatment (p<0.001). When the patients were divided into two groups, seronegative and seropositive, DAS-28 scores were found to be significantly decreased after treatment in both groups. Table 1. Disease activity rates before and after treatment. Disease activity Before MTX treatment (n, %) MTX treatment 3rd month (n, %) MTX treatment 6th month (n, %) Remission 0 30 (%41.0) 48 (%65.8) Low 0 14 (%19.3) 13 (%17.8) Moderate 27 (%37.0) 26 (%35.6) 11 (%15.1) High 46 (%63.0) 3 (%4.1) 1 (%1.3) 73 73 73 Remission + Low 0 44 (%60.3) 61 (%83.6) Moderate + High 73 (%100) 29 (%39.7) 12 (%16.4) 73 73 73 Conclusion Methotrexate is the first recommended conventional DMARD when diagnosed in patients with rheumatoid arthritis. However, clinical practice for monotherapy or combination use is quite heterogeneous. In this study, it was shown that the efficacy of MTX monotherapy was high in patients who were planned as the first conventional DMARD strategy, and the rate of patients who achieved the goal the sixth months increased. Reference [1]Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol . 2021;73(7):1108-1123. Acknowledgements: NIL. Disclosure of Interests None Declared.