title: Long-term continuation of methotrexate therapy in giant cell arteritis patients in clinical practice.
abstract: OBJECTIVE
  To assess the long-term continuation of methotrexate (MTX) in a cohort of patients with giant cell arteritis (GCA) in daily clinical practice. Factors associated with its discontinuation rate were also investigated.
  
  
  METHODS
  A longitudinal study from 1991-2014, was performed. GCA patients with MTX and followed-up in a rheumatology outpatient clinic of Madrid during the study period were included.
  
  
  METHODS
  discontinuation of MTX due to: adverse drug reactions (ADR moderate and severe); inefficacy; sustained clinical response; patient decision. Covariables: sociodemographic, clinical and therapy. Incidence rates (IR) of MTX discontinuation per 100 patient-years with their 95% confidence interval (CI) were estimated using survival techniques. Factors associated to specific discontinuation causes were analysed using Cox models.
  
  
  RESULTS
  We included 108 patients (244 patient-years). The IR was 37.2 [30.3-45.7]. The IR due to ADR, severe ADR, sustained clinical response and inefficacy was 20.8 [15.8-27.4]; 5.7 [3.3-9.6]; 8.2 [5.3-12.7] and 2.8 [1.3-6.0], respectively. Regarding multivariate analysis, younger patients, baseline cardiovascular disease, taking more glucocorticoids and lower initial doses of MTX were associated to a higher discontinuation rate due to inefficacy. Factors influencing the suspension due to ADRs were: older age, baseline. Chronic obstructive pulmonary disease, higher baseline erythrocyte sedimentation rate, several specific clinical patterns at diagnosis, and higher maximum dose of MTX during the follow up. In the final model for sustained clinical response older patients and more recurrences were independently associated to less discontinuation rate.
  
  
  CONCLUSIONS
  We provide further data of the potential safety of long-term MTX in the management of GCA. We have also found several factors influencing the continuation of MTX.
authors.affiliation: Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid; and Universidad Camilo José Cela, Madrid, Spain. lleon.hcsc@salud.madrid.org.
authors.forename: Leticia
authors.initials: L
authors.lastname: Leon
authors.affiliation: Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Rodriguez-Rodriguez
authors.affiliation: Rheumatology Unit, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Dalifer
authors.initials: D
authors.lastname: Freites
authors.affiliation: Rheumatology Unit, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Lucia
authors.initials: L
authors.lastname: Arietti
authors.affiliation: Rheumatology Unit, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Morado
authors.affiliation: Rheumatology Unit, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Vadillo
authors.affiliation: Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Lamas
authors.affiliation: Rheumatology Unit, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Fernandez
authors.affiliation: Rheumatology Unit, Hospital Clínico San Carlos, Madrid; and Medicine Department, Universidad Complutense, Madrid, Spain.
authors.forename: Juan Angel
authors.initials: JA
authors.lastname: Jover
authors.affiliation: Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Spain.
authors.forename: Lydia
authors.initials: L
authors.lastname: Abasolo
mesh_terms: D015897:Comorbidity; D004334:Drug Administration Schedule; D004347:Drug Interactions; D013700:Giant Cell Arteritis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D015999:Multivariate Analysis; D061214:Patient Safety; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D008727:Methotrexate