Sergeant et al., 2018

Prediction of primary non-response to methotrexate therapy using demographic, clinical and psychosocial variables: results from the UK Rheumatoid Arthritis Medication Study (RAMS)

At a glance

Objective

To identify baseline predictors of non-response to MTX and combine these into a prediction algorithm.

Related articles

For more articles on prediction of MTX treatment response, see Duong et al., 2022, Myasoedova et al., 2021, Castrejón et al., 2016.

Link

DOI: https://doi.org/10.1186/s13075-018-1645-5

Background

• MTX is the DMARD of choice in anti-rheumatic treatment
• Response to MTX varies between patients

Methods

• Participants from the UK multi-center prospective observational study RAMS (RA medication study)
• MTX-naïve patients
• Non-response was defined as “no response” after the EULAR response criteria (see also Smolen et al., 2020), discontinuation of MTX due to inefficacy or starting biologic therapy
• Tested association of baseline demographic, clinical and psychosocial predictors with non-response using logistic regression
• AUC and calibration plots to assess predictive performance

Results

• 43% of patients were classified as non-responders
• independent multivariable predictors of MTX non-response were RF negativity, higher HAQ, higher TJC, lower DAS28 and higher Hospital Anxiety and Depression Scale anxiety score
• Optimism-corrected (huh?) AUC was 0.74

Conclusions

• First MTX non-response model to be developed in a large cohort where MTX starters where analysed with demographic, clinical and psychosocial predictors
• Anxiety is a predictor of non-response and could be addressed at treatment commencement