What question did this study set out to answer?

The research aims to evaluate the optimisation of methotrexate treatment before escalation to biologics in patients with rheumatoid arthritis.

April 5, 2026Open Access

Real-world epidemiology and management of patients with rheumatoid arthritis treated with methotrexate in France: a decade after methotrexate first recommendations

Key Points

The research aims to evaluate the optimisation of methotrexate treatment before escalation to biologics in patients with rheumatoid arthritis.
Used claims data from the French national insurance database.
Identified patients with rheumatoid arthritis who initiated methotrexate between 2016 and 2021.
Followed patients initiating methotrexate in 2016-2017 to assess efficacy and costs associated with treatment escalation.
52,462 patients initiated methotrexate, with a two-year persistence rate of 73.7%.
17.5% escalated to biologics, with many not fully optimised on methotrexate prior to escalation.
Mean costs increased significantly from €6218 before escalation to €13,131 after.

Abstract

ABSTRACTObjectives Methotrexate (MTX) is the primary systemic first-line treatment of rheumatoid arthritis (RA). Following the treat-to-target principle, MTX dose and administration route should be optimised before considering advanced therapies (biologic/targeted synthetic disease-modifying antirheumatic drugs b/tsDMARDs), notably in case of insufficient response or intolerance. This study examined patients with RA initiating MTX, assessed MTX optimisation before b/tsDMARD escalation, and evaluated b/tsDMARD economic impact. Methods This observational cohort study used claims data from the French national insurance database, identifying patients with RA (International Classification of Diseases–10th revision M05/M06) who began MTX treatment between January 1, 2016 and December 31, 2021. Among them, patients initiating MTX in 2016-2017 were followed through the end of the study or death. MTX persistence and b/tsDMARD escalation were analysed using the Kaplan-Meier estimator. Costs were described for a 1-year period before and after b/tsDMARD escalation. Results Between 2016 and 2021, 52,462 patients with RA initiated MTX (≈8700/y), mostly orally (79.1%). Mean (SD) age was 60.8 (14.3) years, with 71.0% of women. Two-year MTX persistence was 73.7% (73.0%-74.4%), increasing by ≈20 points in the case of form switch (from 66.8% to 83.8%). Also, 17.5% (16.9%-18.1%) of patients escalated to b/tsDMARD. Among the 3582 patients who escalated to b/tsDMARD, 1121 (31.3%) were treated with oral MTX and were not optimised with subcutaneous MTX before b/tsDMARD. Mean (SD) costs increased from €6218 (€12,259) in the year before to €13,131 (€10,408) the year after b/tsDMARDs initiation. Conclusions Despite a high persistence, many patients escalated to b/tsDMARDs without complete optimisation. Full optimisation of MTX in terms of dose and administration route could be one therapeutic means of delaying escalation to b/tsDMARD, thus preserving future treatment options.

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Cite This Study

Flipo et al. (Wed,) studied this question.

synapsesocial.com/papers/69d1fc4fa79560c99a0a1ea7 https://doi.org/https://doi.org/10.1016/j.ero.2026.03.003

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