Withdrawal of MTX in rheumatoid arthritis patients on bDMARD/tsDMARD plus methotrexate at target: a systematic review and meta-analysis
Pooled result · Change in DAS28Result — go to the resultIncrease in DAS28 0.20 95% CI 0.09–0.32Authors' conclusion
Withdrawing MTX slightly increases the RA disease activity in patients treated at target with bDMARDs/tsDMARDs plus MTX and has limited effects for patients with deep remission.
Study context
- Population
- Patients with RA at target after treatment with bDMARDs/tsDMARDs plus MTX
- Participants
- 1,430 patients6 randomized controlled trials (RCTs)
- Comparison
- MTX withdrawal (tapering off or discontinuing) vs continuation of bDMARD/tsDMARD plus MTX combination therapy
- Withdrawaln = 734
- Continuationn = 696reference
- Outcome
- Change from withdrawal in DAS28 at the endpoint
Methodological detailsrandom-effects models, noninferior RCTs
- Random-effects models
- Noninferior RCTs
Pooled result
Change in DAS28
Increase in DAS28
0.20
95% CI 0.09–0.32
Withdrawalvs Continuation
increase in DAS28 0.20 (95% CI 0.09–0.32)
As reported in the abstract
Further pooled results
| Outcome | Estimate | |
|---|---|---|
| LDA by DAS28 (<3.2)I2 = 0% · random-effects model | RR for LDA 0.88 (95% CI 0.80–0.97) | |
| Remission by DAS28MTX withdrawal did not decrease remission rates | RR for remission 0.90 (CI 0.81–1.01) | |
| Remission by SDAI | RR for remission 0.93 (CI 0.77–1.11) | |
| Remission by CDAI | RR for remission 0.90 (CI 0.74–1.11) | |
| ACR/EULAR Boolean remission | RR for remission 0.95 (CI 0.70–1.29) | |
| 0.512Ratio (log scale) |
Original publication
Withdrawal of MTX in rheumatoid arthritis patients on bDMARD/tsDMARD plus methotrexate at target: a systematic review and meta-analysis. Rheumatology (Oxford). Published 20 September 2022. doi:10.
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