ATLANTA — Methotrexate use is strongly associated with longer survival in rheumatoid arthritis patients.
After taking into consideration the propensity for prescribing methotrexate, prednisone, and anti–tumor necrosis factor (TNF) agents over time, and after adjusting for potential confounding factors such as disease severity, a strong protective effect on mortality was shown for methotrexate (adjusted hazard ratio 0.23) but not for prednisone (adjusted hazard ratio 1.80), said Dr. Mary Chester Wasko.
Combined treatment with methotrexate and prednisone also had a significant protective effect (hazard ratio 0.34).
“Since methotrexate appeared to be strongly protective with respect to survival in these analyses, and because methotrexate and prednisone are often prescribed together in practice, we questioned whether there might be an interaction between the two drugs with respect to survival,” said Dr. Wasko of the University of Pittsburgh.
Indeed, the strength of the association between methotrexate and improved mortality was only modestly reduced when methotrexate was used in combination with prednisone, she added.
Anti-TNF agents were associated with a slightly decreased risk of mortality. Although the result was not statistically significant (adjusted hazard ratio 0.15), follow-up was limited, as the analyses were based on only 10 deaths out of 598 treated patients with only 5 years of follow-up after these drugs were approved. Additional follow-up is needed to strengthen the results.
Dr. Wasko and her colleagues used the Arthritis, Rheumatism, and Aging Medical Information Systems (ARAMIS) database of patients from 10 U.S. rheumatology practices for their study. The median age of the 5,629 participants was 58 years, 75% were female, 90% were white, and follow-up was a median of 4 years and 3 months. A total of 1,027 patients died during 36,612 patient years of observation.
Patients were evaluated biannually from 1981 to 2003 using the Health Assessment Questionnaire (HAQ).
They reported on demographics, health status (including comorbidities), and medication use.
The outcome of interest was all-cause mortality as confirmed by next of kin.
http://www.rheumatologynews.com/article/S1541-9800(11)70030-8/fulltextI hope it's true! how's that association w/ enbrel? Finally!!!