NEW YORK. According to Reuters Health, February 26, 2002, Rheumatoid arthritis (RA) patients are more likely to continue methotrexate therapy than other disease modifying antirheumatic drugs (DMARDs), according to a report published in the February issue of The Journal of Rheumatology.

Dr. Alexandros A. Drosos and colleagues, from the University of Ioannina in Greece, performed a long-term observational study in a group of 428 patients with early RA who were started on a DMARD. The observational period ran from 1987 to 1999.

The most common first-choice DMARD was D-penicillamine followed by hydroxychloroquine, methotrexate, cyclosporin A, and intramuscular gold, the investigators note. Methotrexate was the most commonly prescribed drug at the second prescription.

Methotrexate had the highest 5-year treatment continuation rate at 55%, followed by cyclosporin A at 44%. The lowest continuation rate, 17%, was noted with D-penicillamine, but IM gold and hydroxychloroquine had similarly low rates. Inefficacy was the main reason for discontinuing hydroxychloroquine, while adverse effects were the predominant cause of D-penicillamine discontinuation.

While methotrexate and cyclosporin A were superior to the other agents, after 6 or 7 years treatment discontinuation becomes a problem when any single agent is employed. "Combination therapy with methotrexate and cyclosporin A might improve efficacy after this point," the researchers suggest.

J Rheumatol 2002;29:261-266.