Department of Pharmacy Practice, Karnataka College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
Background Methotrexate (MTX) is a first-line therapy for rheumatoid arthritis (RA) and widely used in psoriatic arthritis (PsA). Therapy is often interrupted due to adverse events, comorbidities and patient or disease-related factors. This study evaluated patterns, reasons, and outcomes of MTX discontinuation and resumption in routine practice.MethodsThis single-center, retrospective study reviewed medical records of 100 adults (50 RA, 50 PsA) who received oral MTX between 2015 and 2023. MTX discontinuation was defined as therapy cessation or a gap >60 days and resumption as any reinitiation post-discontinuation. Successful resumption required continuation for ?3 months with documented disease stability or improvement, with or without dose adjustment. Associations were analyzed using ?², t-tests, Mann–Whitney U, and trend analyses, with p<0.05 considered significant.ResultsRA patients had a higher comorbidity burden and longer MTX exposure than PsA patients. ADRs were the leading cause of discontinuation in RA (n=28, 56%), whereas inefficacy (n=10, 20%) and patient preference (n=16, 32%) predominated in PsA. MTX resumption was attempted in 26 RA (52%) and 28 PsA (56%) patients, with success in 16 RA (32%) and 18 PsA (36%). Dose adjustments were required in 16 RA (32%) and 22 PsA (44%), and ADR recurrence occurred in 6 patients (12%) in both groups. Higher comorbidity burden was significantly associated with increased ADRs and lower likelihood of successful resumption. Conclusion MTX discontinuation and resumption patterns differ between RA and PsA and are influenced by comorbidity burden. Individualized management and monitoring may improve MTX persistence and outcomes.
Methotrexate (MTX) is widely recommended as a first-line conventional synthetic disease-modifying antirheumatic drug (csDMARD) for rheumatoid arthritis (RA). It continues to play an important role in the management of psoriatic arthritis (PsA), either as monotherapy or in combination with other systemic therapies.1-3 Its longstanding use is supported by established efficacy in RA, favourable cost-effectiveness, and extensive clinical experience. In PsA, despite variability in therapeutic response and evolving treatment paradigms, MTX remains commonly prescribed in routine clinical practice, particularly for peripheral joint involvement and as an anchor drug alongside biologic agents.Despite its clinical utility, long-term treatment persistence with MTX is frequently compromised. Evidence from retrospective analyses and registry-based studies consistently identifies adverse drug reactions (ADRs), hepatotoxicity, gastrointestinal intolerance, laboratory abnormalities, perceived inefficacy, comorbid conditions, and patient-related factors as major contributors to treatment interruption or permanent discontinuation.4-7 Notably, the relative contribution of these factors appears to differ between RA and PsA, reflecting disease-specific characteristics, treatment expectations, and patterns of concomitant therapy. These observations underscore the limitations of extrapolating MTX treatment outcomes across inflammatory arthritis without condition-specific evaluation.While the determinants of MTX discontinuation have been extensively described, the clinical course following treatment interruption remains insufficiently explored. The post-discontinuation period represents a critical phase in disease management, as interruption of MTX may precipitate disease flare, necessitate treatment escalation, or result in prolonged reliance on corticosteroids or alternative systemic agents. Resumption of MTX after discontinuation may be hindered by recurrence of prior adverse effects, persistent laboratory abnormalities, patient apprehension, and the availability of alternative therapies. However, few studies have systematically examined challenges associated with MTX resumption or identified factors influencing successful reinitiation in routine clinical practice.5,8Given MTX’s central role in RA and PsA, understanding both discontinuation and resumption determinants is clinically important. This study retrospectively examines patterns, reasons, and outcomes of MTX discontinuation and resumption in routine clinical practice, aiming to identify disease-specific factors affecting treatment persistence and successful reinitiation.
MATERIALS AND METHODS
Study Design and Data Source
A single-center, retrospective observational study was performed at a tertiary care hospital in South India with data collection conducted between January 2024 and August 2024. Medical records of adult patients (≥18 years) with a confirmed diagnosis of RA or PsA who had received oral MTX between January 2015 and December 2023 were reviewed. The study size was determined by the number of eligible patients meeting inclusion criteria during the study period. All patients were prescribed folic acid 5 mg orally once weekly on days when MTX was not administered. Data were obtained exclusively from existing electronic health records (EHRs) and case files from inpatient and outpatient services. All clinical assessments, laboratory investigations, and disease activity scores had been performed as part of routine care by the treating physicians. The study involved reviewing and interpreting physician-documented information on treatment patterns, medication use, and clinical outcomes, including adverse events and reasons for MTX discontinuation or resumption. No additional assessments, interventions, or prospective monitoring were performed. The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.9
Study Population
Patients were included if they were adults (≥18 years) with a documented diagnosis of RA or PsA and had at least three months of follow-up after MTX discontinuation or resumption during the study period. Patients were excluded if they were pregnant or lactating, had autoimmune diseases other than RA or PsA, or received MTX for non-standard indications such as oncology. Additional exclusion criteria included insufficient follow-up (less than three months) after MTX discontinuation or resumption and a documented history of MTX intolerance prior to the study period. Potential documentation and selection bias inherent to retrospective record review were acknowledged.
Variables and Definitions
Data collected included patient demographics, comorbid conditions, MTX dosing (initial and final doses expressed in mg/week), concomitant medications, and documented adverse drug reactions (ADRs). Comorbidity burden was operationalized as a simple count variable (0, 1, 2, or ≥3 comorbidities) due to incomplete availability of data required for validated weighted comorbidity indices. Cumulative MTX exposure was defined as the total duration of MTX therapy.
MTX discontinuation was defined as documented cessation of therapy or a treatment gap exceeding 60 days. MTX resumption was defined as any reinitiation of MTX following discontinuation. Fully or partially successful resumption was defined as continuation of MTX therapy for at least three months with documented disease stability or improvement. Disease stability or improvement was determined based on treating physician documentation, including symptom burden, absence of documented disease flare, and lack of therapy escalation, as formal disease activity scores were not consistently available in the retrospective records. Fully successful resumption referred to continuation without dose modification, whereas partially successful resumption required MTX dose adjustment to maintain disease stability or improvement. Reasons for MTX discontinuation and resumption, including ADRs, inadequate response, patient preference, and disease remission, were extracted from medical records. As multiple reasons could be documented for a single patient, percentages may exceed 100%.
Outcome Measures
The primary outcome of the study was the pattern of MTX discontinuation and resumption among patients with RA and PsA. Secondary outcomes included the association between comorbidity burden and the occurrence of ADRs, differences in MTX dosing and cumulative exposure between RA and PsA cohorts, recurrence of ADRs following MTX resumption, and the type of alternative therapy initiated after MTX discontinuation.
Statistical Analysis
Continuous variables were summarized as mean ± standard deviation (SD) or median with interquartile range (IQR), based on data distribution. Categorical variables were presented as frequencies and percentages. Between-group comparisons of continuous variables were performed using Student’s t-test or the Mann–Whitney U test, as appropriate, while categorical variables were compared using the χ² test or Fisher’s exact test. Comorbidity burden was categorized as an ordinal variable (0, 1, 2, or ≥3 comorbid conditions). Associations between comorbidity burden and MTX-related outcomes were assessed using Pearson’s χ² test, with a χ² test for trend applied to evaluate successful MTX resumption. For statistically significant associations, effect size was quantified using Cramér’s V. All analyses were conducted using complete cases only. Data were organized and tabulated using Microsoft Excel, and statistical analyses were conducted using IBM SPSS Statistics (IBM Corp., Armonk, NY, USA). No sensitivity analyses were performed. A two-sided p value <0.05 was considered statistically significant.
Ethics approval
This retrospective observational study was conducted using existing medical records and did not involve direct patient contact or intervention. Ethical approval was waived by the Institutional Ethics Committee as the study involved secondary analysis of anonymized routine clinical data, in accordance with institutional policy. Patient confidentiality was strictly maintained, and all data were anonymized prior to analysis.
RESULTS
Baseline demographic, clinical, and treatment characteristics
Baseline demographic characteristics, comorbidity profiles, MTX therapy details, and concomitant csDMARD use in patients with RA and PsA are presented in Table 1. The two groups were comparable in terms of age and sex distribution, with no statistically significant differences observed. Differences were noted in the distribution of comorbidities between the groups. Hypertension, hypothyroidism, anaemia of chronic disease, renal impairment, and interstitial lung disease were more prevalent in the RA group, whereas type 2 diabetes mellitus was more common among patients with PsA. The overall comorbidity burden also differed significantly, with RA patients more frequently presenting with multiple comorbidities. MTX initiation and final weekly doses were similar between groups; however, the duration of MTX therapy was significantly longer in patients with RA. Concomitant csDMARD use differed between the groups, with hydroxychloroquine and sulfasalazine prescribed more frequently in the RA cohort, while leflunomide use was comparable. Cyclosporine use was limited to a small proportion of RA patients.
Table 1. Baseline characteristics, methotrexate therapy, and concomitant medications
|
Variable |
RA (n = 50) |
PsA (n = 50) |
p-value |
|
Demographics |
|
|
|
|
Age, years, mean ± SD |
53.53 ± 16.77 |
52.59 ± 16.43 |
0.78 |
|
Female sex, n (%) |
38 (76) |
36 (72) |
0.65 |
|
Comorbidities, n (%) |
|
|
|
|
Hypertension |
30 (60) |
19 (38) |
0.04* |
|
Type 2 diabetes mellitus |
22 (44) |
34 (68) |
0.02* |
|
Dyslipidaemia |
12 (24) |
17 (34) |
0.37 |
|
Hypothyroidism |
26 (52) |
14 (28) |
0.01* |
|
Coronary artery disease |
8 (16) |
3 (6) |
0.20 |
|
Anaemia of chronic disease |
16 (32) |
2 (4) |
<0.001* |
|
Acute kidney injury / Chronic kidney disease |
14 (28) |
2 (4) |
0.002* |
|
Interstitial lung disease |
10 (20) |
0 (0) |
<0.001* |
|
Number of comorbidities per patient |
|
|
|
|
1 comorbidity |
2 (4) |
33 (66) |
- |
|
2 comorbidities |
19 (38) |
11 (22) |
- |
|
≥3 comorbidities |
29 (58) |
6 (12) |
<0.001* |
|
Methotrexate therapy |
|
|
|
|
Initial MTX dose (mg/week), median (IQR) |
7.5 (7.5–10) |
7.5 (5–7.5) |
0.18 |
|
Final MTX dose (mg/week), median (IQR) |
7.5 (7.5–20) |
7.5 (7.5–15) |
0.24 |
|
Duration of MTX therapy (months), median (IQR) |
35 (12–84) |
8 (5–12) |
<0.001* |
|
Concomitant csDMARDs, n (%) |
|
|
|
|
Hydroxychloroquine |
24 (48) |
8 (16) |
<0.001* |
|
Sulfasalazine |
12 (24) |
4 (8) |
0.03* |
|
Leflunomide |
6 (12) |
2 (4) |
0.14 |
|
Cyclosporine |
4 (8) |
0 (0) |
0.04* |
RA: rheumatoid arthritis; PsA: psoriatic arthritis; AKI: acute kidney injury; CKD: chronic kidney disease; DMARD: disease-modifying antirheumatic drug; csDMARDs: conventional synthetic DMARDs; IQR: interquartile range; MTX: methotrexate. Values are expressed as n (%) unless otherwise indicated. Age is presented as mean ± standard deviation; other continuous variables are presented as median (interquartile range). *p < 0.05 indicates statistical significance. Empty cells were replaced with a hyphen (-) where comparisons were not applicable.
Reasons for MTX discontinuation
Table 2 summarizes the specific reasons for methotrexate discontinuation in RA and PsA patients. In RA, ADRs were the most common cause, with mucositis (10 [20%]) and leukopenia (10 [20%]) predominating, followed by gastrointestinal intolerance (8 [16%]). Hematological (pancytopenia 8 [16%]) and hepatic toxicities (transaminitis 8 [16%]) were also observed, while pulmonary and renal toxicities occurred exclusively in RA. Among PsA patients, inefficacy (10 [20%]) and patient-related factors, including poor compliance (10 [20%]) and preference (6 [12%]), were the leading reasons for discontinuation. Disease remission influenced therapy interruption in both groups, whereas procedural requirements and pregnancy planning were less frequent. Multiple reasons per patient were possible, reflecting the multifactorial nature of methotrexate discontinuation.
Table 2. Documented reasons for methotrexate discontinuation in rheumatoid arthritis and psoriatic arthritis
|
Category |
Specific cause |
RA (n = 50), n (%) |
PsA (n = 50), n (%) |
|
Adverse drug reactions |
Mucositis |
10 (20) |
2 (4) |
|
Gastrointestinal intolerance |
8 (16) |
2 (4) |
|
|
Diarrhoea |
2 (4) |
1 (2) |
|
|
Symptomatic infection |
4 (8) |
2 (4) |
|
|
Fatigue |
1 (2) |
2 (4) |
|
|
Hyperuricemia |
0 (0) |
2 (4) |
|
|
Hematological toxicity |
Pancytopenia |
8 (16) |
4 (8) |
|
Leukopenia |
10 (20) |
3 (6) |
|
|
Neutropenia |
2 (4) |
1 (2) |
|
|
Thrombocytopenia |
4 (8) |
2 (4) |
|
|
Hepatic toxicity |
Transaminitis |
8 (16) |
4 (8) |
|
Liver fibrosis / chronic liver disease |
4 (8) |
2 (4) |
|
|
Pulmonary / renal toxicity |
Interstitial lung disease |
4 (8) |
0 (0) |
|
Rising serum creatinine |
2 (4) |
0 (0) |
|
|
Disease-related reasons |
Disease remission |
8 (16) |
4 (8) |
|
Inefficacy |
2 (4) |
10 (20) |
|
|
Patient-related reasons |
Poor compliance |
0 (0) |
10 (20) |
|
Patient preference |
0 (0) |
6 (12) |
|
|
Procedure-related reasons |
Surgery |
6 (12) |
0 (0) |
|
Invasive procedures |
4 (8) |
0 (0) |
|
|
Other reasons |
Pregnancy planning |
2 (4) |
0 (0) |
RA: rheumatoid arthritis; PsA: psoriatic arthritis; ILD: interstitial lung disease. Percentages are calculated based on the total number of patients in each disease group. Percentages exceed 100% due to multiple documented reasons per patient. Other invasive procedures include diagnostic or therapeutic interventions such as biopsies, endoscopy, or minor procedures not classified as surgery.
MTX resumption and post-resumption outcomes
MTX resumption was attempted in 26 RA patients (52%) and 28 PsA patients (56%), most commonly triggered by disease flare. Full or partial resumption was defined as continuation of therapy for at least three months with documented disease stability or improvement, with or without dose adjustment. This outcome was achieved in 16 RA patients and 18 PsA patients of the total cohort; among patients who attempted reinitiation, this corresponded to 61.5% in RA and 64.3% in PsA. Dose adjustments were required in 16 RA patients (32%) and 22 PsA patients (44%). Post-resumption outcomes included mild flare, disease stability, or disease progression or relapse, as shown in Table 3. Follow-up duration and timing after methotrexate resumption were variable and were not standardized due to the retrospective nature of the study.
Table 3. Methotrexate resumption profile and outcomes in rheumatoid arthritis and psoriatic arthritis
|
Category |
Outcome |
RA (n = 50), n (%) |
PsA (n = 50), n (%) |
|
Resumption status |
Attempted resumption |
26 (52) |
28 (56) |
|
Fully / partially successful resumption |
16 (32) |
18 (36) |
|
|
Resumption triggered by disease flare |
14 (28) |
18 (36) |
|
|
Median time to reinitiation (months, range) |
3 (3-30) |
2 (2-4) |
|
|
Resumption characteristics |
Dose adjustment required on resumption |
16 (32) |
22 (44) |
|
ADR recurrence after resumption |
6 (12) |
6 (12) |
|
|
Challenges during resumption |
Compliance issues |
6 (12) |
10 (20) |
|
Follow-up delay impacting resumption |
4 (8) |
8 (16) |
|
|
Post-resumption outcomes |
Mild flare after resumption |
10 (20) |
10 (20) |
|
Disease stability after resumption |
10 (20) |
12 (24) |
|
|
Disease progression / relapse |
4 (8) |
4 (8) |
RA: rheumatoid arthritis; PsA: psoriatic arthritis; ADR: adverse drug reaction. Percentages exceed 100% due to multiple documented reasons per patient.
Association between comorbidity burden and MTX related outcomes
As shown in table 4, comorbidity burden, classified as 0, 1, 2, or ≥3 documented conditions, was significantly associated with the occurrence of ADRs during MTX therapy (Pearson chi-square = 8.01, df = 3, p = 0.037; Cramér’s V = 0.40), indicating a moderate effect size. No significant association was observed between comorbidity burden and ADR recurrence following MTX resumption (Pearson chi-square = 0.97, df = 3, p = 0.61).
Table 4. Association between comorbidity burden and MTX-related outcomes (N = 100)
|
Outcome Variable |
Statistical Test |
df |
p Value |
Effect Size |
|
Occurrence of ADRs |
Pearson χ² |
3 |
0.037* |
0.40 (Cramér’s V) |
|
ADR recurrence after resumption |
Pearson χ² |
3 |
0.61 |
- |
|
Successful MTX resumption |
χ² test for trend |
- |
0.044* |
- |
ADR: adverse drug reaction; MTX: methotrexate. *p < 0.05 indicates statistical significance. Effect size is provided where applicable. A hyphen (-) denotes an outcome or statistic not applicable.
A significant decreasing trend in successful MTX resumption was observed with increasing comorbidity burden (chi-square test for trend, p = 0.044). As shown in Figure 1, the likelihood of achieving successful resumption declined progressively with higher comorbidity counts in both rheumatoid arthritis and psoriatic arthritis.
Percentages represent the proportion of patients achieving fully or partially successful resumption among those who attempted methotrexate reinitiation.
Figure 1. Trend in methotrexate resumption success across increasing comorbidity burden in rheumatoid arthritis and psoriatic arthritis
DISCUSSION
This single-center retrospective analysis provides valuable insights into MTX discontinuation and resumption patterns in patients with RA and PsA. While MTX remains a cornerstone therapy in both conditions, the findings of this study highlight that the reasons for treatment interruption, tolerance profiles, and post-discontinuation management strategies differ between RA and PsA. These disease-specific differences are critical to understanding long-term treatment persistence.
Previous studies suggested that MTX discontinuation in RA was relatively uncommon and rarely driven by laboratory abnormalities alone.10 However, post-hoc analyses in the context of vaccination trials indicate that brief MTX interruption (up to 2 weeks) does not significantly increase RA disease activity, whereas longer holds (≈4 weeks) may lead to transient increases in flares that resolve after resumption.11 In the present study, ADRs were the most frequently documented reason for MTX discontinuation in RA, whereas inefficacy and patient-related factors predominated in PsA. This aligns with observational data reporting higher flare risks following long-term MTX withdrawal in RA.12
Long-term MTX survival appears influenced more by cumulative exposure and patient characteristics than by disease type alone.13 Consistent with this, patients with RA in this study had longer MTX exposure and a higher comorbidity burden, which likely contributed to the observed rates of hematological, hepatic, and metabolic toxicities. Although prior Japanese studies suggest that factors such as higher MTX dose and shorter disease duration affect tolerability, specific comorbidities such as renal or pulmonary disease were not formally identified as predictors.14 Interestingly, although MTX persistence is generally higher in RA than PsA, direct comparisons of long-term toxicity between RA and PsA remain limited, and such differences should be interpreted with caution.15
In PsA, MTX discontinuation was less commonly due to ADRs and more often linked to suboptimal response, poor adherence, and patient preference. Registry-based studies similarly report lower MTX retention in PsA compared with RA.16 Non-adherence, particularly with oral MTX, is widely recognized as a contributor to discontinuation in PsA populations.17 Despite these challenges, MTX still demonstrates superior retention compared with other conventional synthetic DMARDs when used as first-line monotherapy in PsA, reinforcing its ongoing clinical relevance.18A key strength of this study lies in its systematic assessment of MTX resumption following treatment interruption, an aspect that remains relatively underexplored in the existing literature. Approximately half of patients in both RA and PsA attempted MTX reinitiation, most commonly due to disease flare. However, fully or partially successful resumption was achieved in only one-third of patients overall. Dose adjustments were frequently required, underscoring the cautious re-titration approaches frequently adopted in routine clinical practice.19 Recurrence of ADRs after resumption occurred in 12% of patients, consistent with general reports of cumulative and recurrent MTX toxicity, although the precise rate may vary between cohorts.20Comorbidity burden emerged as a key factor influencing MTX outcomes. Patients with multiple comorbid conditions experienced more ADRs and were less likely to successfully resume therapy. This finding reinforces prior evidence that comorbid disease and polypharmacy substantially influence MTX safety profiles. Potential drug-drug interactions, primarily involving proton pump inhibitors and selected antibiotics, were identified in a subset of patients. While no clinically significant interaction-related adverse events were documented in this cohort, such interactions are well recognized to increase MTX exposure and toxicity risk, particularly in vulnerable populations.21Following MTX discontinuation, patients with RA and PsA received a wide range of alternative systemic therapies, often in combination. Among conventional synthetic DMARDs, hydroxychloroquine was the most frequently used overall, predominantly in RA, followed by sulfasalazine and cyclosporine. Less commonly prescribed agents included azathioprine, cyclophosphamide, and iguratimod. These prescribing patterns are consistent with established treatment algorithms following MTX failure, particularly in RA, where csDMARD combinations remain common prior to biologic escalation.22 In PsA, the broader use of alternative agents reflects disease heterogeneity and differing therapeutic targets.Biologic DMARDs were administered to nearly one-quarter of patients, with tumor necrosis factor-α inhibitors used more frequently in RA than PsA. Targeted synthetic DMARDs demonstrated disease-specific utilization patterns, with phosphodiesterase-4 inhibitors predominantly used in PsA and Janus kinase inhibitors more frequently prescribed in RA. Corticosteroids were the most commonly used adjunctive therapy, particularly in PsA, reflecting their continued role in short-term symptom control despite known long-term risks. Acitretin use was limited to PsA, consistent with its dermatologic indication profile. The frequent use of combination regimens underscores the therapeutic complexity following MTX discontinuation.Toxicity patterns observed in this study align with existing evidence emphasizing the importance of careful monitoring for hepatic and hematological adverse effects, particularly in patients with psoriasis and PsA receiving MTX.23 Case reports suggest that concomitant use of PPIs may impair MTX elimination and contribute to pancytopenia in rare instances, though the clinical relevance of this interaction in low dose MTX therapy remains uncertain and is better established in high dose MTX settings.24 Beyond pharmacologic toxicity, medication-use errors also contributed to MTX discontinuation. Severe hematological toxicity was observed in a small subset of patients who inadvertently administered MTX daily rather than weekly, resulting in myelosuppression and necessitating treatment cessation. Similar findings have been reported in poison center data and pharmacovigilance studies, where unintentional dosing errors have been identified as a preventable yet potentially fatal cause of MTX toxicity.25 These findings emphasize the importance of patient education, clear prescribing, and structured follow-up during MTX initiation or resumption, when dosing errors are most likely. Folate supplementation remains an essential adjunct to mitigate toxicity while maintaining therapeutic benefit.26Overall, this study suggests that MTX discontinuation in RA and PsA is influenced by distinct disease-related factors, whereas successful resumption appears to be more strongly associated with patient comorbidity burden and individualized management strategies. These findings support a structured, risk-adapted approach to MTX resumption that integrates comorbidity assessment, dose individualization, and close monitoring to optimize long-term treatment persistence and disease control.
CONCLUSION
MTX discontinuation in RA and PsA is influenced by disease-specific factors, with ADRs predominating in RA and inefficacy or patient preference more commonly driving discontinuation in PsA. Approximately one-third of patients successfully resumed MTX, often requiring dose adjustment, while recurrence of ADRs was uncommon. Higher comorbidity burden was associated with increased ADR occurrence and a reduced likelihood of successful MTX resumption. These findings provide insights on patterns of MTX discontinuation and reinitiation in routine clinical practice and support cautious reintroduction in selected patients with appropriate monitoring. Further studies with larger cohorts, standardized disease activity assessments, and longer follow-up are needed to identify predictors of sustained MTX resumption and long-term disease control in inflammatory arthritis.
LIMITATIONS
This study is limited by its single-center, retrospective design, which may be associated with documentation and selection bias. Owing to the retrospective nature of the data and the limited sample size, formal multivariable adjustment for potential confounders was not undertaken; instead, stratified and comparative analyses were employed to examine associations. Standardized disease activity measures (e.g., DAS28, PASDAS) were not consistently documented in the medical records. Concomitant therapies beyond MTX were not systematically assessed, and institution-specific clinical practices may have influenced discontinuation decisions. Follow-up after MTX resumption was variable and non-standardized, limiting evaluation of long-term outcomes. Additionally, the total number of patients receiving MTX during the study period was unavailable, precluding estimation of the true frequency of discontinuation events.
ABBREVIATIONS
ADR: Adverse Drug Reaction;
csDMARD: Conventional Synthetic Disease-Modifying Antirheumatic Drug;
DMARD: Disease-Modifying Antirheumatic Drug;
EHR: Electronic Health Records;
IQR: Interquartile Range;
MTX: Methotrexate;
PsA: Psoriatic Arthritis;
RA: Rheumatoid Arthritis.
REFERENCES
C. Vanlalawmpuii, Blessy K. George, Balakeshwa Ramaiah, Biaktluangi, Patterns and Factors Influencing Methotrexate Discontinuation and Resumption in Rheumatoid and Psoriatic Arthritis: A Retrospective Observational Study, Int. J. of Pharm. Sci., 2026, Vol 4, Issue 2, 2454-2465. https://doi.org/10.5281/zenodo.18667289
10.5281/zenodo.18667289
