Patients with IBD discontinue methotrexate at higher rate than thiopurines
Patients with inflammatory bowel disease discontinued methotrexate therapy at twice the rate seen in those who used optimized thiopurine therapy, according to study results.
Abhinav Vasudevan, MPH, PhD, of the department of gastroenterology and hepatology at Eastern Health Australia, and colleagues wrote that intolerances to immunomodulators are common, and concern remains about their long-term safety despite their relatively positive efficacy.
“The choice between different immunomodulators is likely driven by clinician experience and preference, given the lack of comparative data and the recommendation that either treatment can be used as maintenance therapy for Crohn’s disease,” they wrote. “Yet, this decision-making has significant implications for the patient in terms of disease control but also quality of life, medication adherence and in turn, adverse effects may negatively impact their further engagement with their treating clinician.”
Researchers conducted a retrospective cohort study comprising data from 782 patients who commenced thiopurine or methotrexate therapy for IBD between 2004 and 2016. Of that group, 244 received methotrexate with folate (31%) and 538 received thiopurine therapy.
Investigators found that patients on methotrexate were typically older (aged 43 vs. 36 years), had a higher rate of immunomodulator intolerance (54% vs. 3%) and had a longer disease duration (6 vs. 5 years; all P < .001) than patients who received thiopurines.
Overall, 208 patients discontinued therapy due to adverse events, including 40% on methotrexate and 19% on thiopurines (P < .001). A higher percentage of patients in the methotrexate group discontinued therapy due to nausea (18% vs. 4%), fatigue (7% vs. 2%) and hepatotoxicity (8% vs. 2%; all P < .001) than in the thiopurine group.
“Despite the more intensive use of biologics and focus on efficacy, an enhanced understanding of the long-term tolerability of drugs with an important place in the therapeutic armamentarium, including immunomodulators, remains critical to a harmonious integration of patients’ disease outcomes, quality of life and safety,” Vasudevan and colleagues wrote.