Methotrexate may produce a substantial gain in survival among rheumatoid arthritis patients.

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04/05/2002

By Harvey McConnell

Methotrexate may produce a substantial gain in survival among rheumatoid

arthritis patients.

Methotrexate produces such a benefit " largely by reducing cardiovascular

mortality, " reports Dr Hyon Choi from Harvard Medical School and Harvard

School of Public Health, and Dr Frederick Wolfe from University of Kansas

School of Medicine, Kansas City, Kansas, United States.

Rates of death from cardiovascular disease, infection, and cancer are higher

among people with rheumatoid arthritis.

A number of disease-modifying antirheumatic drugs exist, with low-dose

methotrexate used as the main choice. Many clinical trials have shown

methotrexate, among many drugs, is effective in reducing morbidity, but the

effect on mortality in patients with rheumatoid arthritis has remained

unknown.

The clinicians prospectively studied 1,240 patients with rheumatoid

arthritis seen over the past two decades at the Wichita (Kansas) Arthritis

Center, an outpatient rheumatology facility. Patient details were entered

into a computerized database from the time of their first clinic visit.

Analysis found that 191 individuals died during follow-up and that the

patients who began treatment with methotrexate (588) had more severe

rheumatoid arthritis.

When adjusted for this confounding factor, the clinicians found methotrexate

had a 60 percent survival benefit for all-cause mortality compared with

patients who did not use methotrexate, and a 70 percent survival benefit for

cardiovascular death. Other conventional disease-modifying antirheumatic

drugs did not have a significant effect on mortality.

The clinicians conclude: " Our data indicate that methotrexate may provide a

substantial survival benefit, largely by reducing cardiovascular mortality.

This gain in life expectancy could be considered in selecting a

cost-effective, disease-modifying antirheumatic drug on a long-term basis.

" Additionally, the survival benefit of methotrexate would set a standard

against which new disease-modifying antirheumatic drugs should be compared. "