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. 2022 Nov;4(11):935-941.
doi: 10.1002/acr2.11467. Epub 2022 Aug 15.

Side Effects of Methotrexate and Tumor Necrosis Factor Inhibitors: Differences in Tolerability Among Patients With Psoriatic Arthritis and Rheumatoid Arthritis

Alexis Ogdie  1 , Ervant J Maksabedian Hernandez  2 , Yomei Shaw  3 , Bradley Stolshek  2 , Kaleb Michaud  4
Affiliations

Side Effects of Methotrexate and Tumor Necrosis Factor Inhibitors: Differences in Tolerability Among Patients With Psoriatic Arthritis and Rheumatoid Arthritis

Alexis Ogdie et al. ACR Open Rheumatol. 2022 Nov.

Abstract

Objective: To examine the prevalence of side effects with methotrexate (MTX) and tumor necrosis factor inhibitors (TNFi) among patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA).

Methods: This retrospective analysis, conducted between January 2000 and January 2019, used data from the FORWARD databank. Adult patients enrolled in the registry with self-reported and physician-confirmed diagnosis of PsA or RA were included if they had completed at least one questionnaire before initiating and within 12 months following initiation of MTX or a TNFi. The primary outcome was to examine the prevalence of side effects with MTX and TNFi within the year following treatment initiation. Multivariate logistic regression analysis was performed to examine the association between PsA and RA and the reporting of their side effects.

Results: Overall, 116 patients with PsA and 4247 patients with RA newly initiated MTX, and 124 patients with PsA and 4361 patients with RA newly initiated a TNFi. Patients with PsA were more likely to report MTX-related side effects than those with RA (44.8% vs. 29.4%), whereas similar proportions of patients with PsA and RA reported TNFi-related side effects within the first year (24.2% and 22.8%, respectively). Additionally, patients with PsA initiating MTX were more likely to report nausea, vomiting, abdominal pain, depression, and tinnitus than patients with RA initiating MTX or those with PsA or RA initiating a TNFi.

Conclusion: Patients with PsA reported more side effects than patients with RA, and this difference was more pronounced in those receiving MTX versus TNFi.

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Figures

Figure 1
Figure 1
Proportion of patients reporting side effects within 12 months of initiating therapy. Error bars represent 95% confidence intervals. “TNFi first course” includes only those patients who were TNFi naïve; “TNFi any course” includes patients who had received multiple TNFi courses. MTX, methotrexate; RA, rheumatoid arthritis; PsA, psoriatic arthritis; TNFi, tumor necrosis factor inhibitor.
Figure 2
Figure 2
Patient‐reported side effects of MTX or TNFi among (A) monotherapy users and (B) combination therapy users. MTX, methotrexate; PsA, psoriatic arthritis; RA, rheumatoid arthritis; TNFi, tumor necrosis factor inhibitor.
Figure 3
Figure 3
Patient‐reported symptoms among new initiators of (A) MTX and (B) TNFi. MTX, methotrexate; PsA, psoriatic arthritis; RA, rheumatoid arthritis; TNFi, tumor necrosis factor inhibitor.
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References

    1. Singh JA, Guyatt G, Ogdie A, Gladman DD, Deal C, Deodhar A, et al. Special Article: 2018 American College Of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol 2019;71:5–32. - PMC - PubMed
    1. Rajitha P, Biswas R, Sabitha M, Jayakumar R. Methotrexate in the treatment of psoriasis and rheumatoid arthritis: mechanistic insights, current issues and novel delivery approaches. Curr Pharm Des 2017;23:3550–66. - PubMed
    1. Cronstein BN, Aune TM. Methotrexate and its mechanisms of action in inflammatory arthritis. Nat Rev Rheumatol 2020;16:145–54. - PubMed
    1. Merola JF, Ogdie A. SEAM‐PsA: seems like methotrexate works in psoriatic arthritis? Arthritis Rheumatol 2019;71:1027–9. - PMC - PubMed
    1. Maksabedian Hernandez EJ, Tkacz J, Lopez‐Gonzalez L, Higgins K, Ogdie A, Stolshek BS. Psoriatic arthritis treatment patterns and costs among pharmacologic treatment‐naive patients. Am J Manag Care 2020;26:e252–7. - PubMed