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Minerva Medica 2021 Feb 08

DOI: 10.23736/S0026-4806.21.06902-0


language: English

Long-term methotrexate use in Rheumatoid Arthritis patients: real-world data from the MARTE study

Teodora SERBAN 1 , Roberto ALLARA 2, Valeria AZZOLINI 3, Claudio BELLINTANI 4, Laura BELLOLI 5, Nebiat BELAI BEYENE 6, Romano BUCCI 7, Roberto CAPORALI 8, Antonella CAPPELLI 9, Vincenzo CORBELLI 10, Fabio DE GENNARO 11, Enrico FUSARO 12, Andrea GIUSTI 1, Marcello GOVONI 13, Luca MAGNANI 14, Ciro MANZO 15, Ciro ROMANO 16, Maurizio ROSSINI 17, Daniele SANTILLI 18, Gianantonio SAVIOLA 19, Luigi SINIGAGLIA 20, Gerolamo BIANCHI 1, on behalf of the MARTE study group

1 Dipartimento Apparato Locomotore, S.C. Reumatologia, ASL3 Genovese, Genoa, Italy; 2 SS Reumatologia, Ospedale Sant'Andrea, Vercelli, Italy; 3 Ambulatorio Reumatologia, Ospedale Civile di Ivrea, Ivrea, Torino, Italy; 4 Medicina Generale, ASST Valle Olona presidio di Gallarate, Gallarate, Varese, Italy; 5 S.C. Reumatologia, Dipartimento Medico Polispecialistico, Ospedale Niguarda, Milan, Italy; 6 Gruppo ICP, Ospedale Bassini di Cinisello Balsamo, Cinisello Balsamo, Milan, Italy; 7 SSD Reumatologia, OSP AOU OO.RR.-Foggia, Foggia, Italy; 8 IRCCS Policlinico San Matteo, Pavia, Italy; 9 SS Reumatologia, ASST Settelaghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; 10 UO di Medicina, ASST Lariana, Azienda Ospedaliera S.Anna, Presidio di San Fermo della Battaglia, Como, Italy; 11 US reumatologia, Ospedale di Cremona, ASST di Cremona, Cremona, Italy; 12 SC Reumatologia, AOU Città della Salute e della Scienza, Turin, Italy; 13 University of Ferrara, Azienda Ospedaliera-Universitaria 'S.Anna', Ferrara, Italy; 14 S.C. Reumatologia, Azienda Ospedaliera Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy; 15 Azienda Sanitaria Locale Napoli 3 sud, Ambulatorio di Reumatologia distretto sanitario 59, Sant'Agnello, Naples, Italy; 16 Divisione di Medicina Interna e Immunoallergologia, Seconda Università di Napoli Policlinico Universitario SUN, Naples, Italy; 17 Azienda Ospedaliera Universitaria Borgo Trento, Dipartimento di Medicina Sezione di Reumatologia, Verona, Italy; 18 S.S.D. di Medicina Interna e Reumatologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; 19 Rheumatology and Rehabilitation Unit of the Institute of Castel Goffredo, Maugeri Clinical Scientific Institutes IRCCS, Mantua, Italy; 20 Day Hospital Reumatologia, Azienda Ospedaliera Istituto Ortopedico G. Pini, Milan, Italy


OBJECTIVE: The MARTE study investigated the demographic, clinical, and therapeutic characteristics of rheumatoid arthritis (RA) patients ongoing methotrexate (MTX) treatment for longer than 8 years.
METHODS: This cross-sectional, observational study considered 587 RA patients from 67 Rheumatology Units across Italy. Data collected included demographic, clinical, and therapeutic characteristics, focusing on MTX prescription patterns (route of administration, dosing regimens, treatment duration, and discontinuation).
RESULTS: 90.6% of patients received one conventional synthetic Disease Modifying Anti Rheumatic Drug (csDMARD) as initial therapy, with treatment started within the first 3 months from diagnosis in half of the patients. MTX was the first csDMARD in 46.2% of patients. The prevalent route of administration at diagnosis was the intramuscular (60.5%), while at study entry (baseline) 57.6% were receiving subcutaneous MTX. Patients who required a higher MTX dose at study entry were those who received a significantly lower starting MTX dose (p<0.001). Significantly higher MTX doses were currently required in men (p<0.001), current smokers (p=0.013), and overweight patients (p=0.028), whereas patients on oral therapy received significantly lower doses of MTX (p<0.001).
CONCLUSIONS: The MARTE study confirms once again the potential of the proper use of MTX in the treatment of RA. Data from our study suggest that a higher dose of MTX should be used since the first stages in overweight patients, men, and smokers.

KEY WORDS: Methotrexate; Rheumatoid arthritis; Long-term treatment; Real-world data

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