Document Detail


Propensity-adjusted association of methotrexate with overall survival in rheumatoid arthritis.
MedLine Citation:
PMID:  23044791     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: While medications used to treat rheumatoid arthritis (RA) may affect survival in RA, few studies take into account the propensity for medication use, which may reflect selection bias in treatment allocation in survival models. We undertook this study to examine the relationship between methotrexate (MTX) use and mortality in RA, after controlling for individual propensity scores for MTX use.
METHODS: We studied 5,626 RA patients prospectively for 25 years to determine the risk of death associated with MTX use, modeled in time-varying Cox regression models. We used the random forest method to generate individual propensity scores for MTX use at study entry and during followup in a time-varying manner; these scores were included in the multivariate model. We also investigated whether selective discontinuation of MTX immediately prior to death altered the risk of mortality, and we examined the association of duration of MTX use with survival.
RESULTS: During followup, 666 patients (12%) died. MTX use was associated with reduced risk of death (adjusted hazard ratio 0.30 [95% confidence interval 0.09-1.03]). Selective MTX cessation immediately before death did not account for the protective association of MTX use with mortality. Only MTX use for >1 year was associated with lower risks of mortality, but associations were not stronger with longer durations of use.
CONCLUSION: MTX use was associated with a 70% reduction in mortality in RA.
Authors:
Mary Chester M Wasko; Abhijit Dasgupta; Helen Hubert; James F Fries; Michael M Ward
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, N.I.H., Intramural    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  65     ISSN:  1529-0131     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-29     Completed Date:  2013-04-11     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  334-42     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 by the American College of Rheumatology.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antirheumatic Agents / therapeutic use*
Arthritis, Rheumatoid / drug therapy,  mortality*
Female
Follow-Up Studies
Humans
Male
Methotrexate / therapeutic use*
Middle Aged
Prospective Studies
Questionnaires
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
AR-43584/AR/NIAMS NIH HHS; M01 RR000056/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Antirheumatic Agents; YL5FZ2Y5U1/Methotrexate
Comments/Corrections
Comment In:
Arthritis Rheum. 2013 Feb;65(2):307-9   [PMID:  23044815 ]
Erratum In:
Arthritis Rheum. 2013 May;65(5):1231

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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