An analysis of South African patients with rheumatoid arthritis with reference to methotrexate therapy retention

Abstract

Background: Methotrexate (MTX) is a Disease-Modifying Antirheumatic Drug (DMARD) for treating various types of inflammatory arthritis, including Rheumatoid Arthritis (RA).

Objective: This article evaluates MTX retention rates and reasons for discontinuation in patients with RA in South Africa. The article also seeks to establish and draw attention to factors that may affect retention.

Method: The study population comprised of 230 patients with RA treated with MTX attending the Rheumatology Department of the Tygerberg Academic Hospital.

Results: Seventy nine patients (34.3%) terminated MTX and 151 patients continued giving a retention rate of 65.7%. The reasons for MTX termination were persistent high disease activity and presumed ineffectiveness (30.4%), nausea and vomiting (25.3%), non-compliance (11.4%), lung toxicity (8.9%), pregnancy-related (7.6%), and hepatotoxicity (5.1%). Clinical factors were not significant predictors of MTX adherence and MTX retention increased with age. Patients aged 65 years and older were twice as likely to have multiple comorbidities and were more likely to continue with treatment.

Conclusions: The duration of MTX treatment correlated with increased age. High retention rate of MTX is encouraging, as it remains the anchor drug among DMARDs in the treatment of RA. Further large scale, prospective, multicenter studies are needed to clearly understand MTX retention rates in patients with RA.

Key words: Methotrexate, Therapy, Retention, Rheumatoid Arthritis, Patients, South Africa