Tapering or discontinuation of methotrexate in stable disease- opinions from rheumatoid arthritis patients and rheumatology providers at two academic healthcare centers

BACKGROUND: Current treatment guidelines for rheumatoid arthritis (RA) favor discontinuation of methotrexate (MTX) over biologic (b) DMARDs. To assess acceptability of this approach, we conducted a cross-sectional study evaluating the perspectives of patients and providers on MTX tapering at one urban and one rural health care center. METHODS: Rheumatologists and patients were surveyed at the two health centers, one in an urban location and one with a predominantly rural area. Patient surveys collected demographics, history of MTX use, and views on tapering. Provider surveys included questions about years of rheumatology practice and strategies being employed for tapering. Data was analyzed using chi-square and Wilcoxon rank sum tests in both questionnaire groups. RESULTS: Surveys were collected over a 3-year period, from January 2020 through the end of 2022. Of the 143 patient respondents, 78% were female and 86% were White. Median duration of RA was 12 years. Tapering trials of MTX were more frequent at the urban facility (p = 0.02) and were more often considered in males with stable disease activity (p = 0.005, and p = 0.042,) and those with longer disease duration. Tapering concerns were greater for female patients on MTX for at least 8 years (p = 0.046). Surveys collected from 16 urban providers and 8 rural providers showed that those with more than 15 years of experience were more likely to consider tapering if patients were concurrently on other treatments favorable for tapering (p = 0.019) and were less likely to consider patient preferences against tapering (p = 0.004). None of the other differences between the two centers were significant. CONCLUSION: We identified factors influencing tapering decisions for both patients and rheumatology providers, including age, race, sex, RA duration and provider's years of experience. Consideration of these will facilitate designing acceptable future approaches to MTX tapering in patients with stable RA.