COMPARISON OF METHOTREXATE WITH AZATHIOPRINE OR 6-MERCAPTOPURINE IN REFRACTORY RHEUMATOID ARTHRITIS: A LIFE-TABLE ANALYSIS

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Abstract
Methotrexate (MTX) appears to be useful in patients with rheumatoid arthritis (RA) refractory to othe drugs but its long-term toxicity and efficacy are uncertain. A retrospective study of MTX in such patients i comparison with the purine analogues, azathioprine and 6-mercaptopurine was made using life-table analysis. Eighty-four patients took MTX in a median dose of 7.5 mg/week whilst 55 received purin analogues, 100 mg/day (median). By 12 months, 19.3% of patients had ceased MTX due to toxicit) compared with 29.3% for purine analogues. Toxicity severe enough to warrant stopping therapy wa uncommon after 8 months with either drug. At 12 months 61.5% of the MTX patients had achieve defined criteria of improvement compared with 25.6% for the purine analogues (p < 0.05). The number c patients improving on purine analogues did not increase substantially after 6 months, whereas the numbe improving with MTX continued to 12 months. MTX in a low-dose regimen is useful in refractory RA an superior to low-dose purine analogues.