Vasculitis & polymyalgia rheumatica
Comparison of methotrexate and azathioprine as the first-line steroid-sparing immunosuppressive agents in patients with Takayasu's arteritis
Authors' conclusion
Remission, relapse, radiographic progression and drug survival rates of AZA and MTX were similar for patients with TAK receiving an IS agent as the first-line f therapy. The rate of vascular surgery was higher and the rate of GC dose reduction was lower with AZA compared to MTX at the end of the follow-up.
Study context
- Population
- TAK patients receiving an immunosuppressive (IS) agent plus glucocorticoids (GCs) as initial therapy, 10 tertiary centresF/M: 260/41
- Participants
- 301 patients
- Exposure
- Methotrexate (MTX) vs AZA as first-line IS agent with GCs
- MTXn = 204
- AZAn = 77reference
Methodological detailsmulticentre, matched analysis (age, gender, diffuse aortic involvement)
- Multicentre
- Matched analysis (age, gender, diffuse aortic involvement)
Main finding
As reported in the abstract
- Remission, relapse, radiographic progression and adverse effect rates similar between MTX and AZA
Observational data: associations, not effects.
Further findings
Vascular surgery
P = 0.001
GCs ≤5 mg/day at end of follow-up
P = 0.034
Drug survival · median 48 months
P = 0.34
Events
| Outcome | MTX | AZA |
|---|---|---|
| IS discontinued due to remission | 12 | 6 |
- IS discontinued due to remission — Total discontinued
- 18
- IS discontinued due to remission — Still in remission at end of mean 69.4 (±50.9) months follow-up
- 16
Vascular surgery
- Vascular surgery rate also higher with AZA in matched analysis
IS discontinued due to remission
- Relapse after discontinuation (at 2 and 6 months)
Safety
- Adverse effect rates similar between MTX and AZA
Original publication
Comparison of methotrexate and azathioprine as the first-line steroid-sparing immunosuppressive agents in patients with Takayasu's arteritis. Semin Arthritis Rheum. Published 8 April 2024. doi:10.
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