Can RA patients taper MTX from targeted therapy?

A recent study has found that tapering methotrexate (MTX) from targeted therapy in patients with controlled rheumatoid arthritis (RA) is feasible, but this may result in a 10-percent decrease in the ability to sustain remission for up to 18 months.

A team of investigators conducted a systematic review and meta-analysis of studies reporting remission outcomes after tapering MTX from targeted therapies in RA. These studies were obtained using the databases of Medline, Embase, and the Cochrane Library. Random-effects models were used to perform the meta-analysis. The investigators also created forest and funnel plots.

Ten studies, including a total of 2,000 patients with RA, met the eligibility criteria. These studies assessed MTX being tapered from combination treatment with tumour necrosis factor inhibitors, tocilizumab, abatacept, and tofacitinib. In terms of study design, nine were randomized and one observational. Three studies focused on early RA (ie, <1 year).

In addition, MTX tapering was gradual in two studies and rapid in eight. Follow-up duration ranged from 3‒18 months in randomized trials and up to 3 years in observational studies.

Meta-analysis revealed that patients who tapered MTX from targeted therapy had a 10-percent reduction in their ability to sustain remission (overall pooled risk ratio, 0.90, 95 percent confidence interval, 0.84‒0.97). No heterogeneity was seen (I², 0 percent; p=0.94). Publication bias was minimal, as indicated by the funnel plot.

“Longer follow-up studies with attention to radiographic, functional, and patient-reported outcomes are needed,” the authors said. “The risk of disease worsening should be discussed with the patient with careful follow-up and prompt retreatment of disease worsening.”