Methotrexate and leflunomide survival in patients with psoriatic arthritis

Abstract:The objectives of this study were to estimate the survival rate of the most frequently used DMARDs in a cohort of PsA patients and factors associated with a higher survival rate. Methods: Patients ≥ 18 years of age with PsA according to CASPAR criteria, belonging to the RAPSODIA cohort were studied. Socio-demographic, clinical and treatment data were collected. Statistical analysis: Kaplan Meier survival curves and log rank were used to analyse and compare drugs’ survival rate. Cox proportional analysis was performed to determine associated factors with drug survival. Results: 87 patients with PsA were included with a median age of 52 years (IQR 40.2-61.7) and a slight female predominance (52.9%). Seventy patients (80.5%) received MTX, 23 (32.9%) had to discontinue it due to adverse events (65%) or treatment failure (35%). The median survival time of MTX treatment was 13 years (IQR 8.5-17.4). The cumulative survival rate after 10 years of treatment was 55%, being significantly higher among patients receiving concomitant steroid therapy (median 16.4 ± 2.3 years vs. 10 ± 2 years, p=0.01). Of the 16 patients receiving LFN, 56.25% had to discontinue, estimating a median survival time of 6 years (IQR 1.6-10.3). The cumulative survival rate after 10 years was 35%. Using a cut-off value of 50 years, elderly patients had a higher drug survival (median 5.5 ± 1.5 years vs. 3 ± 1 years, p=0.03). Conclusion: MTX was the most frequently DMARD used. MTX cumulative survival was greater than that of LFN and was favoured by concomitant steroid therapy. LFN survival was higher amongst elderly patients.