Sarah R Kingsbury, Puvan Tharmanathan, Ada Keding, Fiona E Watt, David L Scott, Edward Roddy, Fraser Birrell, Nigel K Arden, Mike Bowes, Catherine Arundel, Michelle Watson, Sarah J Ronaldson, Catherine Hewitt, Michael Doherty, Robert J Moots, Terence W O'Neill, Michael Green, Gulam Patel, Toby Garrood, Christopher J Edwards, Phil J Walmsley, Tom Sheeran, David J Torgerson, Philip G Conaghan
{"title":"口服甲氨蝶呤减轻膝骨关节炎疼痛：随机安慰剂对照临床试验。","authors":"Sarah R Kingsbury, Puvan Tharmanathan, Ada Keding, Fiona E Watt, David L Scott, Edward Roddy, Fraser Birrell, Nigel K Arden, Mike Bowes, Catherine Arundel, Michelle Watson, Sarah J Ronaldson, Catherine Hewitt, Michael Doherty, Robert J Moots, Terence W O'Neill, Michael Green, Gulam Patel, Toby Garrood, Christopher J Edwards, Phil J Walmsley, Tom Sheeran, David J Torgerson, Philip G Conaghan","doi":"10.7326/M24-0303","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Treatments for osteoarthritis (OA) are limited. Previous small studies suggest that the antirheumatic drug methotrexate may be a potential treatment for OA pain.</p><p><strong>Objective: </strong>To assess symptomatic benefits of methotrexate in knee OA (KOA).</p><p><strong>Design: </strong>A multicenter, randomized, double-blind, placebo-controlled trial done between 13 June 2014 and 13 October 2017. (ISRCTN77854383; EudraCT: 2013-001689-41).</p><p><strong>Setting: </strong>15 secondary care musculoskeletal clinics in the United Kingdom.</p><p><strong>Participants: </strong>A total of 207 participants with symptomatic, radiographic KOA and knee pain (severity ≥4 out of 10) on most days in the past 3 months with inadequate response to current medication were approached for inclusion.</p><p><strong>Intervention: </strong>Participants were randomly assigned 1:1 to oral methotrexate once weekly (6-week escalation 10 to 25 mg) or matched placebo over 12 months and continued usual analgesia.</p><p><strong>Measurements: </strong>The primary end point was average knee pain (numerical rating scale [NRS] 0 to 10) at 6 months, with 12-month follow-up to assess longer-term response. Secondary end points included knee stiffness and function outcomes and adverse events (AEs).</p><p><strong>Results: </strong>A total of 155 participants (64% women; mean age, 60.9 years; 50% Kellgren-Lawrence grade 3 to 4) were randomly assigned to methotrexate (<i>n</i> = 77) or placebo (<i>n</i> = 78). Follow-up was 86% (<i>n</i> = 134; methotrexate: 66, placebo: 68) at 6 months. Mean knee pain decreased from 6.4 (SD, 1.80) at baseline to 5.1 (SD, 2.32) at 6 months in the methotrexate group and from 6.8 (SD, 1.62) to 6.2 (SD, 2.30) in the placebo group. The primary intention-to-treat analysis showed a statistically significant pain reduction of 0.79 NRS points in favor of methotrexate (95% CI, 0.08 to 1.51; <i>P</i> = 0.030). There were also statistically significant treatment group differences in favor of methotrexate at 6 months for Western Ontario and McMaster Universities Osteoarthritis Index stiffness (0.60 points [CI, 0.01 to 1.18]; <i>P</i> = 0.045) and function (5.01 points [CI, 1.29 to 8.74]; <i>P</i> = 0.008). Treatment adherence analysis supported a dose-response effect. Four unrelated serious AEs were reported (methotrexate: 2, placebo: 2).</p><p><strong>Limitation: </strong>Not permitting oral methotrexate to be changed to subcutaneous delivery for intolerance.</p><p><strong>Conclusion: </strong>Oral methotrexate added to usual medications demonstrated statistically significant reduction in KOA pain, stiffness, and function at 6 months.</p><p><strong>Primary funding source: </strong>Versus Arthritis.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pain Reduction With Oral Methotrexate in Knee Osteoarthritis : A Randomized, Placebo-Controlled Clinical Trial.\",\"authors\":\"Sarah R Kingsbury, Puvan Tharmanathan, Ada Keding, Fiona E Watt, David L Scott, Edward Roddy, Fraser Birrell, Nigel K Arden, Mike Bowes, Catherine Arundel, Michelle Watson, Sarah J Ronaldson, Catherine Hewitt, Michael Doherty, Robert J Moots, Terence W O'Neill, Michael Green, Gulam Patel, Toby Garrood, Christopher J Edwards, Phil J Walmsley, Tom Sheeran, David J Torgerson, Philip G Conaghan\",\"doi\":\"10.7326/M24-0303\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Treatments for osteoarthritis (OA) are limited. Previous small studies suggest that the antirheumatic drug methotrexate may be a potential treatment for OA pain.</p><p><strong>Objective: </strong>To assess symptomatic benefits of methotrexate in knee OA (KOA).</p><p><strong>Design: </strong>A multicenter, randomized, double-blind, placebo-controlled trial done between 13 June 2014 and 13 October 2017. (ISRCTN77854383; EudraCT: 2013-001689-41).</p><p><strong>Setting: </strong>15 secondary care musculoskeletal clinics in the United Kingdom.</p><p><strong>Participants: </strong>A total of 207 participants with symptomatic, radiographic KOA and knee pain (severity ≥4 out of 10) on most days in the past 3 months with inadequate response to current medication were approached for inclusion.</p><p><strong>Intervention: </strong>Participants were randomly assigned 1:1 to oral methotrexate once weekly (6-week escalation 10 to 25 mg) or matched placebo over 12 months and continued usual analgesia.</p><p><strong>Measurements: </strong>The primary end point was average knee pain (numerical rating scale [NRS] 0 to 10) at 6 months, with 12-month follow-up to assess longer-term response. Secondary end points included knee stiffness and function outcomes and adverse events (AEs).</p><p><strong>Results: </strong>A total of 155 participants (64% women; mean age, 60.9 years; 50% Kellgren-Lawrence grade 3 to 4) were randomly assigned to methotrexate (<i>n</i> = 77) or placebo (<i>n</i> = 78). Follow-up was 86% (<i>n</i> = 134; methotrexate: 66, placebo: 68) at 6 months. Mean knee pain decreased from 6.4 (SD, 1.80) at baseline to 5.1 (SD, 2.32) at 6 months in the methotrexate group and from 6.8 (SD, 1.62) to 6.2 (SD, 2.30) in the placebo group. The primary intention-to-treat analysis showed a statistically significant pain reduction of 0.79 NRS points in favor of methotrexate (95% CI, 0.08 to 1.51; <i>P</i> = 0.030). There were also statistically significant treatment group differences in favor of methotrexate at 6 months for Western Ontario and McMaster Universities Osteoarthritis Index stiffness (0.60 points [CI, 0.01 to 1.18]; <i>P</i> = 0.045) and function (5.01 points [CI, 1.29 to 8.74]; <i>P</i> = 0.008). Treatment adherence analysis supported a dose-response effect. Four unrelated serious AEs were reported (methotrexate: 2, placebo: 2).</p><p><strong>Limitation: </strong>Not permitting oral methotrexate to be changed to subcutaneous delivery for intolerance.</p><p><strong>Conclusion: </strong>Oral methotrexate added to usual medications demonstrated statistically significant reduction in KOA pain, stiffness, and function at 6 months.</p><p><strong>Primary funding source: </strong>Versus Arthritis.</p>\",\"PeriodicalId\":7932,\"journal\":{\"name\":\"Annals of Internal Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":19.6000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Internal Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.7326/M24-0303\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/30 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Internal Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.7326/M24-0303","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/30 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Pain Reduction With Oral Methotrexate in Knee Osteoarthritis : A Randomized, Placebo-Controlled Clinical Trial.
Background: Treatments for osteoarthritis (OA) are limited. Previous small studies suggest that the antirheumatic drug methotrexate may be a potential treatment for OA pain.
Objective: To assess symptomatic benefits of methotrexate in knee OA (KOA).
Design: A multicenter, randomized, double-blind, placebo-controlled trial done between 13 June 2014 and 13 October 2017. (ISRCTN77854383; EudraCT: 2013-001689-41).
Setting: 15 secondary care musculoskeletal clinics in the United Kingdom.
Participants: A total of 207 participants with symptomatic, radiographic KOA and knee pain (severity ≥4 out of 10) on most days in the past 3 months with inadequate response to current medication were approached for inclusion.
Intervention: Participants were randomly assigned 1:1 to oral methotrexate once weekly (6-week escalation 10 to 25 mg) or matched placebo over 12 months and continued usual analgesia.
Measurements: The primary end point was average knee pain (numerical rating scale [NRS] 0 to 10) at 6 months, with 12-month follow-up to assess longer-term response. Secondary end points included knee stiffness and function outcomes and adverse events (AEs).
Results: A total of 155 participants (64% women; mean age, 60.9 years; 50% Kellgren-Lawrence grade 3 to 4) were randomly assigned to methotrexate (n = 77) or placebo (n = 78). Follow-up was 86% (n = 134; methotrexate: 66, placebo: 68) at 6 months. Mean knee pain decreased from 6.4 (SD, 1.80) at baseline to 5.1 (SD, 2.32) at 6 months in the methotrexate group and from 6.8 (SD, 1.62) to 6.2 (SD, 2.30) in the placebo group. The primary intention-to-treat analysis showed a statistically significant pain reduction of 0.79 NRS points in favor of methotrexate (95% CI, 0.08 to 1.51; P = 0.030). There were also statistically significant treatment group differences in favor of methotrexate at 6 months for Western Ontario and McMaster Universities Osteoarthritis Index stiffness (0.60 points [CI, 0.01 to 1.18]; P = 0.045) and function (5.01 points [CI, 1.29 to 8.74]; P = 0.008). Treatment adherence analysis supported a dose-response effect. Four unrelated serious AEs were reported (methotrexate: 2, placebo: 2).
Limitation: Not permitting oral methotrexate to be changed to subcutaneous delivery for intolerance.
Conclusion: Oral methotrexate added to usual medications demonstrated statistically significant reduction in KOA pain, stiffness, and function at 6 months.
期刊介绍：
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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