Vol.21 No.6

Original Article

Studies of the efficacy and safety of methotrexate at dosages over 8 mg/week using the IORRA cohort database

Authors

Yohei Seto¹ , Eiichi Tanaka¹ , Eisuke Inoue¹ , Ayako Nakajima¹ , Atsuo Taniguchi¹ , Shigeki Momohara¹ , Hisashi Yamanaka¹

Received:

21 October 2010

Accepted:

7 March 2011

Published online:

20 March 2011

Full Text

PDF　(member's only)

Abstract

The maximum dosage of methotrexate (MTX) for treatment of rheumatoid arthritis (RA) formally approved in Japan is 8 mg/week. We intended to examine the efficacy and safety of MTX at dosages over 8 mg/week in Japanese rheumatoid arthritis patients using the large Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort database. Among 9,122 patients registered in the IORRA database from the October 2000 survey to the October 2007 survey, 5,201 patients who had been treated with MTX were selected. We attempted to overcome the drawbacks innate to nonrandomized studies by using longitudinal analyses and multifactorial logistic regression analyses. Cross-sectional analysis of data obtained from the October 2007 survey indicated that dosages of MTX higher than 8 mg/week were used in 27.5% of patients treated with MTX. Longitudinal analyses based on data from three consecutive phases showed that final Disease Activity Score-28 (DAS28) values were significantly lower
[n = 260, mean difference 0.563, 95% confidence interval
(CI) 0.438-0.688, P<2.2 × 10^-22, two-sided paired t test]
than initial values when MTX was increased from 8 mg/
week or lower to over 8 mg/week. In addition, longitudinal
analyses based on data from two consecutive phases indicated
decreases in DAS28 values of 0.26 ± 1.04 (n = 690,
P = 6.78 × 10^-11, two-sided paired t test) when MTX
dosages were increased from 8 mg/week or lower to over
8 mg/week, compared with decreases of 0.07 ± 0.89
(n = 2,125, P = 0.000307) when the dosage was maintained
at 8 mg/week. The decreases in DAS28 values were
significantly larger in the former than the latter
(P = 2.27 × 10^-6, two-sided unpaired t test). Concerning safety of MTX at dosages over 8 mg/week, we performed logistic regression analysis in which the objective variable was the existence or nonexistence of self-reported ideeffects and the explanatory variable was the MTX dosage in the former phase, with adjustments made for age, sex, body mass index (BMI), steroid administration, folic acid administration, concomitant pulmonary diseases, and renal dysfunction. The results indicated that MTX dosages over 8 mg/week did not have any association with either severe or severe + moderate side-effects. These data regarding both efficacy and safety of MTX at dosages over 8 mg/week in Japanese RA patients would provide the basis for use of the drug at dosages currently not formally approved by the Japanese government.

Key words

Efficacy - Methotrexate - Rheumatoid arthritis - Safety - Treatment