Risk factors associated with relapse after methotrexate dose reduction in patients with rheumatoid arthritis receiving golimumab and methotrexate combination therapy

Aim To identify risk factors for relapse after methotrexate (MTX) dose reduction in rheumatoid arthritis (RA) patients receiving golimumab (GLM)/MTX combination therapy. Method Data on RA patients ≥20 years old receiving GLM (50 mg) + MTX for ≥6 months were retrospectively collected. MTX dose reduction was defined as a reduction of ≥12 mg from the total dose within 12 weeks of the maximum dose (≥1 mg/wk average). Relapse was defined as Disease Activity Score in 28 joints using C‐reactive protein level (DAS28‐CRP) score ≥3.2 or sustained (≥ twice) increase of ≥0.6 from baseline. Results A total of 304 eligible patients were included. Among the MTX‐reduction group (n = 125), 16.8% of patients relapsed. Age, duration from diagnosis to the initiation of GLM, baseline MTX dose, and DAS28‐CRP were comparable between relapse and no‐relapse groups. The adjusted odds ratio (aOR) of relapse after MTX reduction was 4.37 (95% CI 1.16–16.38, P = 0.03) for prior use of non‐steroidal anti‐inflammatory drugs (NSAIDs), and the aORs for cardiovascular disease (CVD), gastrointestinal disease and liver disease were 2.36, 2.28, and 3.03, respectively. Compared to the non‐reduction group, the MTX‐reduction group had a higher proportion of patients with CVD (17.6% vs 7.3%, P = 0.02) and a lower proportion of prior use of biologic disease‐modifying antirheumatic drugs (11.2% vs. 24.0%, P = 0.0076). Conclusion Attention should be given to RA patients with history of CVD, gastrointestinal disease, liver disease, or prior NSAIDs‐use when considering MTX dose reduction to ensure benefits outweigh the risks of relapse.