Persistence With Methotrexate Therapy In Rheumatoid Arthritis At Two Tertiary Care Centres In India

Col. Dr. Vishal Marwaha; Dr. Anuj Singhal; Dr. Neeraj Sidharthan; Dr. Pranav Raman Chickermane; Dr. Rema Ganapathy; Dr. Vaishnavi Sujathen; Dr. Princy Louis Palatty; Dr. Mithun C.B.; Dr. Arun Tiwari

Volume : IX, Issue : XII, December - 2019

Persistence With Methotrexate Therapy In Rheumatoid Arthritis At Two Tertiary Care Centres In India

Col. Dr. Vishal Marwaha, Dr. Anuj Singhal, Dr. Neeraj Sidharthan, Dr. Pranav Raman Chickermane, Dr. Rema Ganapathy, Dr. Vaishnavi Sujathen, Dr. Princy Louis Palatty, Dr. Mithun C. B. , Dr. Arun Tiwari

Abstract :

Background: The goal of rheumatoid arthritis (RA) therapy is to obtain remission or low disease activity. Most guidelines recommend initiation of disease modifying anti–rheumatic drugs (DMARDs) at the time of diagnosis, with methotrexate (MTX) being the DMARD of first choice. Persistence with therapy is one of the key factors determining the outcome. Aim: To investigate the persistence with MTX among RA patients. Method: A prospective observational study was conducted at two tertiary centres of the Armed Forces of India over a period of one year in which 100 (female–71, male– 29) patients with RA satisfying the 1987 ACR classification criteria were enrolled. They were initiated on methotrexate, either as monotherapy (n= 58) or in combination with other DMARDs, i.e, methotrexate with hydroxychloroquine (n=24) and methotrexate with hydroxychloroquine and sulphasalazine (n=18) and followed up once every 4 weeks for a period of at least 6 months. Results: The persistence rate to methotrexate in our study was 88% at 6 months. Reasons for discontinuation (n=12) included lack of tolerability (41.6% of discontinuers), lack of efficacy (8.3%), lost to follow up (25%), poor compliance (16.6%) and prior to conception (8.3%). Conclusions: Lack of tolerability was the leading cause for discontinuation of therapy. A high persistence rate observed in our study could be attributed to the meticulous counseling of patients and the fact that majority of the patients were defence personnel or their relatives.