After combination treatment: Can methotrexate be stopped?

This study examined stopping methotrexate after 6 months of combined treatment with etanercept. Results showed that continuing combination treatment is preferable to stopping methotrexate.

For patients with rheumatoid arthritis, a combination of treatments is often more effective than a single treatment. Methotrexate (Trexall) is generally used as a first treatment choice in many patients. This drug is not always well-tolerated, though, and between 10% and 30% of patients stop treatment due to unwanted side-effects.

Etanercept (Enbrel) is a treatment that blocks the activity of a protein involved in joint inflammation. Etanercept has also been shown to be effective as a first treatment for rheumatoid arthritis (RA). A combination of Etanercept and methotrexate is often used to treat patients with RA not responding to methotrexate treatment alone. It is unclear whether patients using this combination could discontinue methotrexate treatment at some point.

The current study compared disease activity in patients who stopped methotrexate after 6 months of combination treatment with etanercept, to those patients who continued with the combination. The study included 205 patients with RA not responding to methotrexate treatment alone. All patients received a combination of etanercept and methotrexate for 6 months. Patients were then randomly assigned to continue combination treatment (group 1) or continue with etanercept alone (group 2).

Overall, disease activity did not change in group 1, and increased a small amount in group 2.

Among patients who achieved low disease activity after the first 6 months of combination treatment, disease activity scores were similar between groups 1 and 2.

Among patients who did not achieve low disease activity on combination therapy to begin with, disease activity continued to decrease in group 1, while patients in group 2 saw an increase in disease activity scores.

This study concluded that stopping treatment with methotrexate is not recommended for patients currently receiving combination therapy. However, those achieving low disease activity remained so even after stopping methotrexate.

This study was funded by Amgen and Pfizer, the manufacturers of etanercept.