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Psoriatic arthritis
Original research
Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis
  1. Hannah den Braanker1,2,
  2. Kim Wervers2,
  3. Adriana M C Mus2,
  4. Priyanka S Bangoer2,
  5. Nadine Davelaar2,
  6. Jolanda Luime2,
  7. Ilja Tchetverikov3,
  8. J M W Hazes2,
  9. Marijn Vis2,
  10. Erik Lubberts2 and
  11. Marc R Kok1
  1. 1Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, Netherlands
  2. 2Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
  3. 3Department of Rheumatology, Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands
  1. Correspondence to Marc R Kok; KokMR{at}maasstadziekenhuis.nl

Abstract

Objectives Methotrexate (MTX) is currently the recommended first-line therapy for treating psoriatic arthritis (PsA), despite lacking clear evidence. No estimates of efficacy of MTX in usual care and no clear MTX responsive clinical or laboratory variables are currently available. This study describes the response to MTX monotherapy in newly diagnosed patients with PsA in usual care. Second, we compared clinical variables and cytokine profiles in patients responding and not responding to MTX monotherapy.

Methods We used data collected in the Dutch southwest Early Psoriatic Arthritis cohoRt study to select patients with PsA with oligoarthritis or polyarthritis, and at least 1 year follow-up. We analysed disease activity at 6 months of patients who started MTX monotherapy and still used MTX monotherapy 1 year after diagnosis. Cytokine profiles were determined at baseline and after 3 and 6 months with a bead-based multi-immunoassay.

Results We identified 219 patients of which 183 (84%) patients started MTX monotherapy within 6 months after diagnosis. 90 patients used MTX monotherapy throughout the first year of which 44 patients (24%) reached minimal disease activity(MDA) at 6 months, decreasing to 33 patients (18%) after 1 year. Non-responders had significantly higher concentrations of interleukin (IL) 23 and IL-10 before and during MTX therapy.

Conclusions Our results showed that only 18% of patients with PsA are in sustained MDA after 1 year of MTX monotherapy and non-responders more often had IL-23-driven disease. Our results indicate the need for more treat-to-target and personalised therapy strategies in PsA.

  • Methotrexate
  • Psoriatic Arthritis
  • Cytokines
  • Epidemiology
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/rmdopen-2020-001175

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    Footnotes

    • HdB and KW contributed equally

    • Contributors Study concept and design: HdB, KW, JL, IT, JMWH, MV, EL, MRK. Acquisition of data: HdB, KW, AMCM, PSB, ND, IT, MV, MRK. Analysis and interpretation of data: HdB, KW, EL, JMWH, MV, MRK. All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published. MRK had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding Research support for this analysis was funded by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis Pilot Research Grant. The organization had no role in the study design, collection of data, analysis or interpretation of data, nor on the preparation or approval of the manuscript and the decision to submit the manuscript for publication. Research support for conduct of the DEPAR study was provided by the Netherlands Organization for Health Research and Development (ZonMW, grant number 836012002). The organization had no role in the study design, collection of data, analysis or interpretation of data, nor on the preparation or approval of the manuscript and the decision to submit the manuscript for publication.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethical approval information This study was approved by the Medical Research Ethics Committee of the Erasmus University Hospital in Rotterdam, MEC-2012-549. Patients signed informed consent before participating in the study.

    • Data sharing statement The data that support the findings of this study are available from the corresponding author, Marc R Kok, upon reasonable request.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient and public involvement During the feasibility stage, the research questions and the choice for patient-related outcome measures were informed by discussions with patients.