dc.contributor.author |
Tidblad, Liselotte |
dc.contributor.author |
Westerlind, Helga |
dc.contributor.author |
Delcoigne, Bénédicte |
dc.contributor.author |
Askling, Johan |
dc.contributor.author |
Saevarsdottir, Saedis |
dc.date.accessioned |
2024-04-20T01:06:04Z |
dc.date.available |
2024-04-20T01:06:04Z |
dc.date.issued |
2023-12-20 |
dc.identifier.citation |
Tidblad , L , Westerlind , H , Delcoigne , B , Askling , J & Saevarsdottir , S 2023 , ' Comorbidities and chance of remission in patients with early rheumatoid arthritis receiving methotrexate as first-line therapy : a Swedish observational nationwide study ' , RMD Open , vol. 9 , no. 4 . https://doi.org/10.1136/rmdopen-2023-003714 |
dc.identifier.issn |
2056-5933 |
dc.identifier.other |
215146827 |
dc.identifier.other |
53826e0e-71a1-4fe6-839e-a63f2dee487e |
dc.identifier.other |
85180419882 |
dc.identifier.other |
38123483 |
dc.identifier.uri |
https://hdl.handle.net/20.500.11815/4828 |
dc.description |
Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. |
dc.description.abstract |
OBJECTIVES: This study aims to examine whether comorbidities affect the likelihood of reaching primary remission on methotrexate monotherapy as the first disease-modifying antirheumatic drug (DMARD) in early rheumatoid arthritis (RA). METHODS: We used nationwide Swedish clinical and quality registers to collect RA disease activity measures and comorbidity data for patients diagnosed with RA 2007-2020 (n=11 001). The primary outcome was failure to reach 28-joint Disease Activity Score (DAS28) remission at 3 months. Secondary outcomes included Boolean, Simplified Disease Activity Index/Clinical Disease Activity Index remission, European Alliance of Associations for Rheumatology response and no swollen joint count at 3 and 6 months. For each comorbidity, and for combinations thereof, we calculated adjusted relative risks (RRs) of failure to reach remission, using modified Poisson regression. RESULTS: In total, 53% (n=4019/7643) failed to reach DAS28 remission after 3 months of methotrexate monotherapy, ranging from 66% (n=25/38) among patients with chronic kidney disease to 48% (n=154/319) in patients with previous cancer. The risk of not reaching DAS28 remission at 3 months (RR adjusted for sex and age) was increased among patients with endocrine (RR 1.08, 95% CI 1.01 to 1.15), gastrointestinal (RR 1.16, 95% CI 1.03 to 1.30), infectious (RR 1.21, 95% CI 1.06 to 1.38), psychiatric (RR 1.24, 95% CI 1.15 to 1.35) and respiratory comorbidities (RR 1.16, 95% CI 1.01 to 1.32). Having three or more comorbidity categories was associated with a 27% higher risk of DAS28 remission failure at 3 months. A similar pattern was observed for the secondary outcomes. CONCLUSIONS: Comorbidities decrease the chance of reaching remission on methotrexate as DMARD monotherapy in patients with early RA and are important to consider when assessing treatment outcomes. |
dc.format.extent |
558633 |
dc.format.extent |
|
dc.language.iso |
en |
dc.relation.ispartofseries |
RMD Open; 9(4) |
dc.rights |
info:eu-repo/semantics/openAccess |
dc.subject |
Arthritis, Rheumatoid |
dc.subject |
Epidemiology |
dc.subject |
Methotrexate |
dc.subject |
Outcome Assessment, Health Care |
dc.subject |
Rheumatology |
dc.subject |
Immunology and Allergy |
dc.subject |
Immunology |
dc.title |
Comorbidities and chance of remission in patients with early rheumatoid arthritis receiving methotrexate as first-line therapy : a Swedish observational nationwide study |
dc.type |
/dk/atira/pure/researchoutput/researchoutputtypes/contributiontojournal/article |
dc.description.version |
Peer reviewed |
dc.identifier.doi |
10.1136/rmdopen-2023-003714 |
dc.relation.url |
http://www.scopus.com/inward/record.url?scp=85180419882&partnerID=8YFLogxK |
dc.contributor.department |
Faculty of Medicine |