{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T18:24:34Z","timestamp":1788114274400,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,7,5]],"date-time":"2020-07-05T00:00:00Z","timestamp":1593907200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2020,8]]},"abstract":"Objective<\/jats:title>To assess real\u2010world practice patterns surrounding treatment initiation and adjustments over time for methotrexate (MTX<\/jats:styled-content>) and non\u2010MTX<\/jats:styled-content>\u2013based treatment strategies in early rheumatoid arthritis (RA<\/jats:styled-content>).<\/jats:p><\/jats:sec>Methods<\/jats:title>We studied a multicenter, incident early RA<\/jats:styled-content> cohort (enrolled 2007\u20132017 within 1 year of symptoms) who fulfilled American College of Rheumatology\/European League Against Rheumatism criteria. Adult patients with RA<\/jats:styled-content> were eligible if treatment with MTX<\/jats:styled-content> (\u00b1 other disease\u2010modifying antirheumatic drugs [DMARD<\/jats:styled-content>s]) was initiated within 90 days of cohort entry. We compared time until treatment change for 4 initial MTX<\/jats:styled-content>\u2010based therapies and time to second treatment change after the first change. The definition of treatment change included changing of route for MTX<\/jats:styled-content> monotherapy, adding or stopping a DMARD<\/jats:styled-content> or biologic, and changing dose\/frequency of a DMARD<\/jats:styled-content> or biologic.<\/jats:p><\/jats:sec>Results<\/jats:title>There was great variability of treatment at initiation and during therapy adjustment. In 1,484 patients with early RA<\/jats:styled-content>, the majority initiated MTX<\/jats:styled-content> monotherapy (oral or subcutaneous [SC<\/jats:styled-content>]). Patients receiving SC MTX<\/jats:styled-content> monotherapy changed treatment less (45% versus 79%) and remained on treatment longer (hazard ratio [HR<\/jats:styled-content>] 0.52 [95% confidence interval (95% CI<\/jats:styled-content>) 0.4\u20130.67]) than those receiving oral MTX<\/jats:styled-content> monotherapy. Most therapy adjustments involved adding a DMARD<\/jats:styled-content> or changing to a non\u2010MTX DMARD<\/jats:styled-content>. Those adults taking biologics and who were receiving triple therapy had a longer time without treatment change (HR<\/jats:styled-content> 0.26 [95% CI<\/jats:styled-content> 0.16\u20130.42] and HR<\/jats:styled-content> 0.57 [95% CI<\/jats:styled-content> 0.38\u20130.85], respectively).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>We found large variability in the way MTX<\/jats:styled-content>\u2010based therapies are prescribed in clinical practice. Our findings support the use of SC MTX<\/jats:styled-content> monotherapy or MTX<\/jats:styled-content> combination as initial therapy. For subsequent treatment after initial MTX<\/jats:styled-content>\u2010based therapy, those patients initiating either biologics or triple therapy had a longer time to treatment change than oral MTX<\/jats:styled-content> monotherapy.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23927","type":"journal-article","created":{"date-parts":[[2019,5,21]],"date-time":"2019-05-21T08:05:55Z","timestamp":1558425955000},"page":"1104-1111","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Treatment Strategies in Early Rheumatoid Arthritis Methotrexate Management: Results From a Prospective Cohort"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2109-0709","authenticated-orcid":false,"given":"Cristiano S.","family":"Moura","sequence":"first","affiliation":[{"name":"McGill University Montreal Quebec 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