A randomized placebo-controlled trial of methotrexate in psoriatic arthritis

Gabrielle H Kingsley, Anna Kowalczyk, Helen Taylor, Fowzia Ibrahim, Jonathan C Packham, Neil J McHugh, Diarmuid M Mulherin, George D Kitas, Kuntal Chakravarty, Brian D M Tom, Aidan G O'Keeffe, Peter J Maddison, David L Scott

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Abstract

Objective. MTX is widely used to treat synovitis in PsA without supporting trial evidence. The aim of our study was to test the value of MTX in the first large randomized placebo-controlled trial (RCT) in PsA.

Methods. A 6-month double-blind RCT compared MTX (15 mg/week) with placebo in active PsA. The primary outcome was PsA response criteria (PsARC). Other outcomes included ACR20, DAS-28 and their individual components. Missing data were imputed using multiple imputation methods. Treatments were compared using logistic regression analysis (adjusted for age, sex, disease duration and, where appropriate, individual baseline scores).

Results. Four hundred and sixty-two patients were screened and 221 recruited. One hundred and nine patients received MTX and 112 received placebo. Forty-four patients were lost to follow-up (21 MTX, 23 placebo). Twenty-six patients discontinued treatment (14 MTX, 12 placebo). Comparing MTX with placebo in all randomized patients at 6 months showed no significant effect on PsARC [odds ratio (OR) 1.77, 95% CI 0.97, 3.23], ACR20 (OR 2.00, 95% CI 0.65, 6.22) or DAS-28 (OR 1.70, 95% CI 0.90, 3.17). There were also no significant treatment effects on tender and swollen joint counts, ESR, CRP, HAQ and pain. The only benefits of MTX were reductions in patient and assessor global scores and skin scores at 6 months (P = 0.03, P < 0.001 and P = 0.02, respectively). There were no unexpected adverse events.

Conclusions. This trial of active PsA found no evidence for MTX improving synovitis and consequently raises questions about its classification as a disease-modifying drug in PsA.
Original languageEnglish
Pages (from-to)1368-1377
Number of pages10
JournalRheumatology
Volume51
Issue number8
DOIs
Publication statusPublished - Aug 2012

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Kingsley, G. H., Kowalczyk, A., Taylor, H., Ibrahim, F., Packham, J. C., McHugh, N. J., ... Scott, D. L. (2012). A randomized placebo-controlled trial of methotrexate in psoriatic arthritis. Rheumatology, 51(8), 1368-1377. https://doi.org/10.1093/rheumatology/kes001