Table 2

Summary of clinical predictors of response to MTX and other DMARDs.

Factors

Predictor of response?

Comments


Gender

Yes, men respond better to MTX

Both in early and established RA; not extendable to other DMARDs

Age

No

Strong evidence showing lack of influence on MTX responsiveness, a few contradicting studies; probably also no influence on other DMARDs

Ethnicity

Uncertain

Despite the theoretical rationale, more data is needed

Smoking

Likely, active smokers respond worse to MTX

Most studies do not analyze it; however, available studies point to worse response in active smokers; not certain as to extension to other DMARDs

Disease duration

Yes, better response in early RA

Early RA has better response than established RA, but no influence of duration in longstanding disease; controversial results due to methodological heterogeneity

Prior DMARD use

Yes, worse response

Previous DMARD use associated with worse response to MTX and other DMARDs; however, not confirmed in some studies; results likely to be affected by several clinical confounders

Disease activity measured by composite scores

Yes, worse response if higher baseline activity

However, frequently not replicable with different scores; unclear which scores are better, likely to depend on response measures used

Disease activity measured by isolated variables

Uncertain

Contradicting findings; unreliable when variables are used separately

Disability

Uncertain, not likely

No association in most studies; inverse relation between HAQ and response in some early RA studies

Pain global assessment

No

Strong evidence showing lack of influence on response to MTX and other DMARDs; a few contradicting studies

Concomitant NSAIDs

Uncertain

Only two studies suggesting higher response to MTX in NSAIDs users; more data needed

Concomitant corticosteroids

Likely, better response

Although most studies fail to analyze it, combined therapy with steroids seems to have better results than DMARD monotherapy

Radiographic scores

No

Extensively shown that baseline radiographic scores do not predict clinical response to any DMARD


Conclusions and comments are based on the findings reported and discussed in the text. DMARDs, disease modifying anti-rheumatic drugs; HAQ, health assessment questionnaire; MTX, methotrexate; NSAIDs, non-steroidal anti-inflammatory drugs; RA, rheumatoid arthritis.

Romão et al. BMC Medicine 2013 11:17   doi:10.1186/1741-7015-11-17

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