Methotrexate maintenance therapy and quality of life during the targeted therapy era in rheumatoid arthritis

Introduction: The persistence with methotrexate (MTX) to at least 1 year in rheumatoid arthritis (RA) is highly variable. Moreover, the quality-of-life level in patients with RA is often overlooked. The objective of this study was to determine the rate of maintenance at 1 year of combination therapy with different biologics, to analyze predictive factors for MTX maintenance therapy, and to compare evaluation scores and quality of life levels in patients receiving monotherapy (biologic only) versus combination therapy with methotrexate. Patients and methods: We performed a descriptive study of 56 patients with RA meeting the ACR 2010 criteria. Results: Fifty-six patients were included. RF was positive in 61.90% and ACPA was positive in 78.57% of cases. 47.62% were on MTX; 28 patients were on rituximab, 19 patients on tocilizumab, and 9 patients on TNFi. 88.09% had not received bDMARDs previously. 52.38% of patients were on biologic monotherapy. The DAS-28 score improved from 6.6 at baseline (high activity) to 2.9 (low activity). The HAQ functional score was 1.1. The CQR19 score (Compliance Questionnaire Rheumatology) was 55.16, the RAID score (Rheumatoid Arthritis Impact of Disease) was 3.09/10, the SF-36 (Short Form Survey) score was 56/100, and the AIMS score (Arthritis Impact Measurement Scale) was 2.11/10 for social activity, 2.44/10 for pain, 3.3/10 for depression, and 4.1/10 for physical activity. The rate of MTX maintenance therapy at 1 year was 36.84% with rituximab, 64.28% with tocilizumab, and 88% with TNFi. The comparison between combination therapy with MTX and monotherapy groups showed a significant difference in the number of tender joints (NTJ). Regarding predictive factors of MTX maintenance therapy, a significant correlation was found with high baseline DAS-28. Reduced persistence showed significant correlation with non-naïve RA patients (≥1 bDMARD), disease activity score, type of biotherapy, and young age. Increased persistence of combination therapy was associated with male gender and RF seropositivity only. The comparison between the two groups did not find any significant difference in terms of quality-of-life parameters. Conclusion: Drug persistence is an important aspect of treatment effectiveness. For rheumatologists, knowledge of factors that predict whether to maintain combination therapy with methotrexate is of great interest when choosing a new treatment to initiate in patients with RA. Our study did not demonstrate any superiority of combination therapy with methotrexate in improving quality of life.