ArticleEULAR rheumatology open2026
Real-world epidemiology and management of patients with rheumatoid arthritis treated with methotrexate in France: a decade after methotrexate first recommendations.
Article in EULAR rheumatology open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
Objectives: Methotrexate (MTX) is the primary systemic first-line treatment of rheumatoid arthritis (RA). Following the treat-to-target principle, MTX dose and administration route should be optimised before considering advanced therapies (biologic/targeted synthetic disease-modifying antirheumatic drugs [b/tsDMARDs]), notably in case of insufficient response or intolerance. This study examined patients with RA initiating MTX, assessed MTX optimisation before b/tsDMARD escalation, and evaluated b/tsDMARD economic impact. Methods: This observational cohort study used claims data from the French national insurance database, identifying patients with RA (International Classification of Diseases-10th revision M05/M06) who began MTX treatment between January 1, 2016 and December 31, 2021. Among them, patients initiating MTX in 2016-2017 were followed through the end of the study or death. MTX persistence and b/tsDMARD escalation were analysed using the Kaplan-Meier estimator. Costs were described for a 1-year period before and after b/tsDMARD escalation. Results: Between 2016 and 2021, 52,462 patients with RA initiated MTX (≈8700/y), mostly orally (79.1%). Mean (SD) age was 60.8 (14.3) years, with 71.0% of women. Two-year MTX persistence was 73.7% (73.0%-74.4%), increasing by ≈20 points in the case of form switch (from 66.8% to 83.8%). Also, 17.5% (16.9%-18.1%) of patients escalated to b/tsDMARD. Among the 3582 patients who escalated to b/tsDMARD, 1121 (31.3%) were treated with oral MTX and were not optimised with subcutaneous MTX before b/tsDMARD. Mean (SD) costs increased from €6218 (€12,259) in the year before to €13,131 (€10,408) the year after b/tsDMARDs initiation. Conclusions: Despite a high persistence, many patients escalated to b/tsDMARDs without complete optimisation. Full optimisation of MTX in terms of dose and administration route could be one therapeutic means of delaying escalation to b/tsDMARD, thus preserving future treatment options.
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