title: Suboptimal methotrexate use in rheumatoid arthritis patients in Italy: the MARI study.
abstract: OBJECTIVE
  Methotrexate (MTX) is the first choice in the treatment of rheumatoid arthritis (RA), but the doses and regimens vary significantly. For this purpose, we conducted an observational study on the use of MTX for RA in Italy (MARI study).
  
  
  METHODS
  The MARI study included 1,327 RA patients on MTX treatment for at least 12 months, at 60 Italian rheumatology units. Concomitant medications with corticosteroids, other DMARDs or biological therapies were recorded. The clinical assessment included the Disease Activity Score 28 (DAS28) and the serological positivity for the rheumatoid factor or for the anti-citrullinated protein antibodies.
  
  
  RESULTS
  The included patients were treated with either oral (n=288) or parenteral (n=1039) MTX. Only 15.5% of the total number of the patients was on adequate MTX dose (i.e. ≥ 15 mg for the oral route of administration and >12 mg for the parenteral one). The initially established MTX dose was modified in 37.1% of the patients, for intolerance or clinical criteria. A DAS28 remission (DAS28 <2.6) was observed only in 58.5% of the cases, while 52.9% of the patients still presenting an active form of the disease were on suboptimal doses of MTX.
  
  
  CONCLUSIONS
  The weekly dose of MTX prescribed for the treatment of RA is often suboptimal, even in conditions of inadequate control of the disease activity. The recommendations for the use of MTX in RA patients should take into account the efficacy and tolerability data derived from its use in real clinical practice.
authors.affiliation: Rheumatology, Department of Internal Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. luca.idolazzi@univr.it.
authors.forename: L
authors.initials: L
authors.lastname: Idolazzi
authors.affiliation: Rheumatology, Department of Internal Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Adami
authors.affiliation: Rheumatology, Ospedale CTO A. Alesini, ASL Roma C, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Capozza
authors.affiliation: Rheumatology, Ospedale La Colletta, Arenzano, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bianchi
authors.affiliation: Rheumatology, Ospedale San Paolo, Bari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cozzolongo
authors.affiliation: Rheumatology, A.O. Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Epis
authors.affiliation: Rheumatology, Azienda Ospedaliero-Universitaria S.Giovanni Battista, Torino, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Fusaro
authors.affiliation: Rheumatology, Ospedale Policlinico, Bari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Lapadula
authors.affiliation: Rheumatology, Ospedale S. Pietro Fatebenefratelli, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Migliore
authors.affiliation: Rheumatology, A.O. Ordine Mauriziano di Torino, ASL TO1, Torino, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Pellerito
authors.affiliation: Rheumatology, ASL Napoli 1 Centro Distretti 24 -27 -31, Napoli, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pucino
authors.affiliation: Rheumatology, Azienda Ospedaliera Istituto Ortopedico G. Pini, Milano, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Sinigaglia
authors.affiliation: Rheumatology, A.O.U. Policlinico Universitario G. Martino, Messina, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Visalli
authors.affiliation: Rheumatology, Department of Internal Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D062072:Patient Acuity; D012074:Remission Induction / Q000379:methods; D012217:Rheumatoid Factor / Q000097:blood; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D012217:Rheumatoid Factor; D008727:Methotrexate