Determinants for drug survival of Methotrexate in patients with psoriasis, split for different reasons of discontinuation - Results of the prospective MTX-CAPTURE

Abstract

Background

Methotrexate is a widely used treatment for psoriasis. It is important to gain insight into the reasons for discontinuation of methotrexate and determinants for drug survival.

Objectives

To describe 5-year drug survival for methotrexate in patients with psoriasis split for different reasons of discontinuation, and to identify determinants for drug survival.

Methods

Data were extracted from a prospective psoriasis registry of patients treated with methotrexate (MTX-CAPTURE). Drug survival was analyzed using Kaplan-Meier estimates and determinants for discontinuation were analyzed using Cox-regression analysis. Analyses were split for reason of discontinuation: side effects or ineffectiveness.

Results

We included 85 patients treated with methotrexate with a maximum treatment duration of 5.2 years. The overall drug survival rates were 62.7%, 30.1%, and 15.1% after 1, 3, and 5 years, respectively. The median survival was 1.8 years. Fifty-five patients (64.7%) discontinued MTX; reasons were: side effects (34.5%), ineffectiveness (25.5%), combination of side effects and ineffectiveness (12.7%), other reasons (16.4%), and lost to follow-up (10.9%). Most reported side effects were gastrointestinal symptoms, despite folic acid use in 99% of patients. Based on univariate analysis, a high Psoriasis Area and Severity Index and Visual Analogue Scale for disease severity at baseline were possible determinants for a short drug survival.

Conclusion

drug survival of MTX was low with 15% of patients 'on drug' after 5 years. Side effects alone or in combination with inadequate disease control were more important in the context of treatment discontinuation than inadequate disease control solely.

This article is protected by copyright. All rights reserved.

http://ift.tt/2jGIseK