Why carry out this study?

Previous multiple prediction models for non-response to methotrexate (MTX) have been proposed, which all resulted in an area under the curve (AUC) between 0.65 and 0.80, but not all models have been validated.

The purpose of the current study was to externally validate a previously developed prediction model for insufficient response to MTX and to enhance the model’s applicability in clinical practice.

What has been learned from the study?

The prediction model was externally validated with an AUC of 0.75 (95% CI 0.64–0.85), enhanced for clinical applicability (AUC = 0.75, 95% CI 0.69–0.81) and successfully integrated in an online tool “Evidencio”, which can assist clinicians and patients in shared decision-making.

Patients with high risk scores for insufficient response to MTX according to our model integrated in Evidencio can immediately intensify MTX treatment with biologic disease-modifying anti-rheumatoid drugs/conventional synthetic disease-modifying anti-rheumatoid drugs (bDMARDs/csDMARDs) as proposed in the America College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2019 updated guidelines for RA treatment [1], while sufficient responders are spared expensive step-up treatment.

Disease activity in these patients can be tightly controlled during the window of opportunity, resulting in better long-term responses and avoiding unnecessary adverse events of MTX.