Perrotta Fabio Massimo, Ambrosino Pasquale, Lubrano Ennio
Academic Rheumatology Unit, Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy.
Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, 82037 Telese Terme, Italy.
J Clin Med. 2024 Dec 11;13(24):7540. doi: 10.3390/jcm13247540.
: In the era of biotechnological drugs, methotrexate (MTX) still represents the first-line treatment in chronic inflammatory arthritis, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and undifferentiated arthritis (UA). The aim of our study was to evaluate the persistence of MTX as a first-line treatment in a group of patients with chronic inflammatory arthritis. : We conducted a retrospective analysis of a database of outpatients diagnosed with RA, PsA, or UA who visited our Rheumatology Clinic from January 2014 to January 2022. Key demographic and clinical data, including information on comorbidities and treatments, were routinely collected. Kaplan-Meier (KM) curves were used to determine the persistence of MTX during follow-up. : A total of 242 patients with chronic inflammatory arthritis who initiated MTX as first-line therapy and had available clinical data were included. Of these, 130 (53.7%) had RA, 82 (33%) had PsA, and 30 (16.3%) had UA. Overall, the survival rate of MTX at 24 months of follow-up was approximately 60%, while at 48 months and 96 months, it was 40% and 20%, respectively. A statistically significant difference was found between RA and PsA compared to UA (Chi-square test = 14.84; = 0.001). When comparing the KM survival curves of MTX between male and female patients, obese and non-obese individuals, as well as older (age ≥ 50 years) and younger patients (age < 50 years), no statistically significant differences were observed in any of the comparisons. : Our study confirmed the efficacy and overall safety of MTX in RA and PsA, with good persistence even over the long term.
在生物技术药物时代，甲氨蝶呤（MTX）仍是慢性炎症性关节炎（如类风湿关节炎（RA）、银屑病关节炎（PsA）和未分化关节炎（UA））的一线治疗药物。我们研究的目的是评估MTX作为一组慢性炎症性关节炎患者一线治疗药物的持续使用情况。
我们对2014年1月至2022年1月期间到我们风湿科门诊就诊、诊断为RA、PsA或UA的门诊患者数据库进行了回顾性分析。常规收集关键的人口统计学和临床数据，包括合并症和治疗信息。采用Kaplan-Meier（KM）曲线来确定随访期间MTX的持续使用情况。
共有242例开始将MTX作为一线治疗且有可用临床数据的慢性炎症性关节炎患者纳入研究。其中，130例（53.7%）患有RA，82例（33%）患有PsA，30例（16.3%）患有UA。总体而言，随访24个月时MTX的留存率约为60%，而在48个月和96个月时，分别为40%和20%。与UA相比，RA和PsA之间存在统计学显著差异（卡方检验=14.84；P=0.001）。在比较MTX在男性和女性患者、肥胖和非肥胖个体以及年龄较大（年龄≥50岁）和年龄较小患者（年龄<50岁）之间的KM生存曲线时，在任何比较中均未观察到统计学显著差异。
我们的研究证实了MTX在RA和PsA中的疗效和总体安全性，即使长期使用也有良好的留存率。
