The following is a summary of “Can Patients With Controlled Rheumatoid Arthritis Taper Methotrexate From Targeted Therapy and Sustain Remission? A Systematic Review and Metaanalysis,” published in the January 2023 issue of Rheumatology by Meng, et al.
The purpose of this study is to assess the likelihood of relapse in patients with well-controlled rheumatoid arthritis (RA) who attempt to reduce methotrexate (MTX) from targeted therapy. Studies reporting remission outcomes following switching from MTX to targeted treatments in RA were sought by a systematic search of the literature in MEDLINE, Embase, and the Cochrane Library. English-language publications with both full texts and abstracts were considered. Random-effects models were used in the meta-analyses. Plots in the shape of a forest and a funnel were designed.
A total of 10 papers in total were included. Tocilizumab, abatacept, and tofacitinib are tumor necrosis factor inhibitors studied in conjunction with MTX taper. About 9 studies employed a randomized design and 1 was an observational study. Only 3 of the 10 studies looked at RA at its earliest stages (i.e., <1 year). About 2 studies used a slow MTX-tapering method, while 8 used a quick one. Randomized studies had a follow-up period of 3–18 months, whereas the observational study had a follow-up period of up to 3 years. In a meta-analysis of 2000 RA patients from 10 studies, researchers found that patients who switched to targeted therapy and tapered MTX had a 10% decrease in the capacity to prolong remission, with a pooled risk ratio of 0.90 (95% CI 0.84-0.97).
There was no heterogeneity, meaning (I2 = 0, P = 0.94). The publishing bias was low, as shown by our funnel plot. With a 10% drop in the capacity to maintain remission for up to 18 months, patients with controlled RA may withdraw MTX from targeted therapy. Radiographic, functional, and patient-reported outcomes should be evaluated over longer periods of time in future investigations. Careful monitoring and rapid readmission for deteriorating disease should be part of any discussion about the possibility of disease progression with the patient.
Source: jrheum.org/content/50/1/36
