title: Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors: data from the DREAM registry.
abstract: OBJECTIVE
  To study the number of patients that taper or discontinue concomitant methotrexate (MTX) in daily practice in patients with rheumatoid arthritis (RA) treated with tumour necrosis factor inhibitor (TNFi) and to analyse the effects of that adaption on disease activity and drug survival.
  
  
  METHODS
  Data were collected from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Patients who started their first TNFi were included in the study. Treatment effectiveness after MTX tapering or discontinuation was analysed using Disease Activity Score of 28 joints (DAS28). Drug survival of the TNFi was analysed using the Cox proportional hazard model with a time-dependent covariate.
  
  
  RESULTS
  In 458 patients (34%), MTX was tapered, 126 patients (10%) discontinued MTX and 747 patients (56%) continued MTX at the same dose. On average, DAS28 improved after tapering MTX (-0.40, -0.45) and after stopping MTX (-0.28, -0.12) at 6 and 12 months. In the taper group, 21% of the patients relapsed (DAS28 increase >0.6), and in the discontinuation group this was 21% and 24% at 6 and 12 months, respectively. Patients who taper and discontinue MTX have a similar DAS28 score over time as patients who continue MTX. Moreover, there was no influence of tapering or discontinuation of MTX on long-term drug survival of TNFi.
  
  
  CONCLUSIONS
  In daily practice, tapering or discontinuation of concomitant MTX in patients with RA treated with TNFi frequently occurs and it does not seem to influence the average DAS28 over time or the long-term TNFi drug survival. It appears that in daily clinical practice the correct patients are selected to taper or discontinue MTX.
authors.affiliation: Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center , Nijmegen , The Netherlands.
authors.forename: Sofie H M
authors.initials: SH
authors.lastname: Manders
authors.affiliation: Department of Rheumatology , Twente University , Enschede , The Netherlands.
authors.forename: Mart A F J
authors.initials: MA
authors.lastname: van de Laar
authors.affiliation: Radboud Institute for Health Sciences, Rheumatic diseases, Radboud university medical center , Nijmegen , The Netherlands.
authors.forename: Sanne A A
authors.initials: SA
authors.lastname: Rongen-van Dartel
authors.affiliation: Department of Rheumatology , Medical Centre Leeuwarden , Leeuwarden , The Netherlands.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Bos
authors.affiliation: Department of Rheumatology , Rijnstate , Arnhem , The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Visser
authors.affiliation: Department of Rheumatology , Twee Steden Ziekenhuis , Almelo , The Netherlands.
authors.forename: Herman L
authors.initials: HL
authors.lastname: Brus
authors.affiliation: Department of Rheumatology , VieCuri Ziekenhuis , Venlo , The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Jansen
authors.affiliation: Department of Rheumatology , Twente University , Enschede , The Netherlands.
authors.forename: Harald E
authors.initials: HE
authors.lastname: Vonkeman
authors.affiliation: Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center , Nijmegen , The Netherlands.
authors.forename: Piet L C M
authors.initials: PL
authors.lastname: van Riel
authors.affiliation: Radboud Institute for Health Sciences, Health Evidence, Radboud University Medical Center , Nijmegen , The Netherlands.
authors.forename: Wietske
authors.initials: W
authors.lastname: Kievit
keywords: Anti-TNF; DAS28; Methotrexate; Outcomes research; Rheumatoid Arthritis