Sequential treatment strategies following methotrexate inadequate response in rheumatoid arthritis: a real-world retrospective cohort study
Authors' conclusion
While b/tsDMARDs demonstrated superior efficacy and tolerability, approximately one-third of patients achieved remission through MTX dose optimisation, possibly reflecting suboptimal initial dosing. Importantly, prior csDMARD optimisation did not compromise subsequent b/tsDMARD responsiveness.
Study context
- Population
- Rheumatoid arthritis (RA) patients with inadequate response to initial methotrexate (MTX), from health records
- Participants
- 45 / 194 / 37 / 57
- Exposure
- Direct switch to b/tsDMARD vs MTX dose escalation after MTX inadequate response; in dose-escalation non-responders, leflunomide (LEF) vs b/tsDMARD
- Direct b/tsDMARDn = 45
- MTX dose escalationn = 194reference
- LEFn = 37
- b/tsDMARD post-dose escalationn = 57
- Outcome
- 3V-remission (modified EULAR Boolean criteria)
- Follow-up
- 6-month intervals
Methodological detailsreal-world
- Real-world
Main finding
As reported in the abstract
3V-remission
P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | LEF | b/tsDMARD post-dose escalation | P value |
|---|---|---|---|
| 3V-remission among MTX dose escalation non-respondersLEF vs b/tsDMARD post-dose escalation | 43.2% | 50.9% | P = 0.469 |
b/tsDMARD 3V-remission by prior treatment exposure
- After initial MTX
- 62.2%
- Post-dose escalation
- 50.9%
- Post-LEF
- 46.1%
- Overall comparison
- P = 0.417
Safety
| Outcome | LEF | b/tsDMARD post-dose escalation |
|---|---|---|
| Discontinuation among MTX dose escalation non-responders | 21.6% | 1.8% |
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Sequential treatment strategies following methotrexate inadequate response in rheumatoid arthritis: a real-world retrospective cohort study. Clin Exp Rheumatol. Published 26 January 2026. doi:10.
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