ORIGINAL ARTICLE   

Minerva Medica 2021 April;112(2):246-54

DOI: 10.23736/S0026-4806.21.06902-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

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 S.C. Rheumatology, Department of Locomotor System, ASL3 Genovese, Genoa, Italy; ² SS Rheumatology, Sant’Andrea Hospital, Vercelli, Italy; ³ Ambulatory of Rheumatology, Hospital of Ivrea, Ivrea, Italy; ⁴ ASST Valle Olona of Gallarate, General Medicine, Gallarate, Italy; ⁵ S.C. Rheumatology, Polyspecialist Medical Department, Niguarda Hospital, Milan, Italy; ⁶ ICP Group, Bassini Hospital, Cinisello Balsamo, Milan, Italy; ⁷ SSD Rheumatology, University Hospital OO. RR. of Foggia, Foggia, Italy; ⁸ IRCCS San Matteo Polyclinic, Pavia, Italy; ⁹ SS Rheumatology, ASST Settelaghi, Circolo Hospital and Macchi Foundation, Varese, Italy; ¹⁰ Unit of Medicine, ASST Lariana, S. Anna Hospital, San Fermo della Battaglia, Como, Italy; ¹¹ US Rheumatology, Hospital of Cremona, ASST of Cremona, Cremona, Italy; ¹² SC Rheumatology, Città della Salute e della Scienza, Turin, Italy; ¹³ University of Ferrara, S. Anna University Hospital, Ferrara, Italy; ¹⁴ S.C. Rheumatology, IRCCS Arcispedale Santa Maria Nuova Hospital, Reggio Emilia, Italy; ¹⁵ ASL Napoli 3 Sud, Ambulatory of Rheumatology - Sanitary District 59, Sant’Agnello, Naples, Italy; ¹⁶ Division of Internal Medicine and Immuno-allergology, SUN University Hospital, Naples, Italy; ¹⁷ Section of Rheumatology, Department of Medicine, University Hospital of Borgo Trento, Verona, Italy; ¹⁸ S.S.D. Internal Medicine and Rheumatology, University Hospital of Parma, Parma, Italy; ¹⁹ Unit of Rheumatology and Rehabilitation, Institute of Castel Goffredo, IRCCS Maugeri Clinical Scientific Institutes, Mantua, Italy; ²⁰ Day Hospital of Rheumatology, G. Pini Orthopedic Institute, Milan, Italy

BACKGROUND: 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: As initial therapy, 90.6% of patients received one conventional synthetic Disease Modifying Anti Rheumatic Drug (csDMARD), 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; Arthritis, rheumatoid; Long-term care; Citizen science