类风湿性关节炎 (RA) 指南推荐甲氨蝶呤 (MTX) 锚定疗法与生物或靶向合成缓解病情抗风湿药物 (b/tsDMARD)；然而，耐受性问题常常导致不依从。加拿大关于 b/tsDMARD 启动后 MTX 逐渐减量和/或停药的数据很少。该图表回顾评估了 b/tsDMARD 启动后 MTX 逐渐减量或停药的频率，以及对加拿大成人 RA 疾病状态的影响。符合条件的患者在 b/tsDMARD 启动前已接受 MTX  ≥ 3 个月。 b/tsDMARD 连续服用 ≥ 18 个月。排除服用 > 10 mg/天口服泼尼松或等效药物的患者。889 名患者（平均基线 MTX 剂量 19.0 mg/周）开出 b/tsDMARD（肿瘤坏死因子抑制剂 52.1%、Janus 激酶抑制剂 18.3%、白细胞介素- 6 抑制剂 [IL-6i] 11.9%，其他 17.7%）在 22 个加拿大中心进行了评估。 b/tsDMARD 开始后 2 年内，123 名 (13.8%) 患者逐渐减量 MTX，147 名 (16.5%) 患者停药，最常见的原因分别是计划减量 (36.6%) 和患者决定 (27.2%)，而最常见的是通常与 IL-6i 一起使用 (34.9%)。 582 名患者 (65.5%) 的 MTX 剂量保持不变，37 名患者 (4.2%) 的 MTX 剂量增加。缺失的数据限制了 MTX 剂量对某些次要终点影响的解释，并对加拿大风湿病实践中常规使用基于疾病活动测量的目标治疗方法的断言提出了质疑。 30.4% 患有 RA 的加拿大人在 2 年内逐渐减少甲氨蝶呤或停药。 b/tsDMARD 启动后 2 年。许多医疗记录中缺少基线疾病活动指标。然而，对于进行基线评估的患者，MTX 逐渐减量或停药并不会恶化疾病活动性。© 2024。作者。

Rheumatoid arthritis (RA) guidelines recommend methotrexate (MTX)-anchored therapy with biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs); however, tolerability issues often lead to non-adherence. Canadian data on MTX tapering and/or withdrawal following b/tsDMARD initiation are minimal. This chart review assessed frequency of MTX tapering or withdrawal following b/tsDMARD initiation and the impact on disease status in Canadian adults with RA.Eligible patients had received MTX for ≥ 3 months before b/tsDMARD initiation. The b/tsDMARD was prescribed continuously for ≥ 18 months. Patients taking > 10 mg/day oral prednisone or equivalent were excluded.Eight hundred eighty-nine patients (mean baseline MTX dose 19.0 mg/week) prescribed b/tsDMARDs (tumor necrosis factor inhibitor 52.1%, Janus kinase inhibitor 18.3%, interleukin-6 inhibitor [IL-6i] 11.9%, other 17.7%) were evaluated at 22 Canadian centers. Within 2 years of b/tsDMARD initiation, MTX was tapered in 123 (13.8%) patients and discontinued in 147 (16.5%), most commonly due to planned tapering (36.6%) and patient decision (27.2%), respectively, and most commonly with IL-6i use (34.9%). The MTX dose was unchanged for 582 (65.5%) patients and increased for 37 (4.2%). Missing data limit interpretations of MTX dose effects on some secondary endpoints and challenge the assertion that a disease activity measure-based treat-to-target approach is routinely used in Canadian rheumatology practice.Methotrexate tapering or withdrawal occurred in 30.4% of Canadians with RA within 2 years following b/tsDMARD initiation. Baseline disease activity measures were missing from many medical records. However, for patients with baseline assessments, MTX tapering or discontinuation did not worsen disease activity.© 2024. The Author(s).