RESEARCH - Methotrexate reduces cardiovascular mortality in RA patients

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Journal Watch

Summary and Comment

April 26, 2002

Methotrexate Reduces Cardiovascular Mortality in RA Patients

Methotrexate is the main disease-modifying antirheumatic drug that is used

to treat patients with rheumatoid arthritis (RA). The aim of this

prospective observational study was to investigate the effect of

methotrexate therapy on survival among a cohort of 1240 patients (age, >18)

with RA who were followed, on average, for 6 years at a Wichita, Kansas,

arthritis center. During the study, 191 deaths occurred, of which 84 were

attributed to cardiovascular causes.

The 588 patients who were treated with methotrexate (mean dose, 13 mg

weekly) had worse prognostic factors for mortality than did the patients who

weren't treated with methotrexate; however, after adjustment for these

factors, the mortality hazard ratio for methotrexate treatment was 0.4 (0.3

for cardiovascular deaths and 0.6 for noncardiovascular deaths). Both

overall and cardiovascular mortality risk reductions were significant.

Treatment with other disease-modifying antirheumatic drugs, such as

prednisone, sulfasalazine, penicillamine, hydroxychloroquine, and

intramuscular gold, conferred no significant mortality benefit.

Comment: These authors report a 70% reduction in cardiovascular mortality in

rheumatoid arthritis patients who were treated with methotrexate. They

suggest that cardiovascular mortality benefit might have resulted from

improved mobility, increased exercise, and decreased inflammation in

methotrexate-treated patients.

- Sir Jarman, PhD, FRCP, FRCGP, FFPHM

Published in Journal Watch April 26, 2002

Source

Choi HK et al. Methotrexate and mortality in patients with rheumatoid

arthritis: A prospective study. Lancet 2002 Apr 6; 359:1173-7.

http://general-medicine.jwatch.org/cgi/content/full/2002/426/1

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

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