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More Evidence for Subcutaneous MTX - Why Are We Still Using Oral MTX?

Dr. Andy Thompson  Featured
November 18 2014 4:05 PM ET via RheumReports RheumReports

Another poster on the efficacy and tolerability of subcutaneous (SC) methotrexate (MTX) further supports its use over oral (PO) MTX therapy. 

This was a retrospective analysis in Slough, UK from 2001 to present. The investigators identified 182 patients with inflammatory arthritis (RA, PsA, AS, SLE, vasculitis, or UIA) who switched from PO to SC MTX over the study period. The reasons for switching included: intolerance (55), inefficacy (118), and unknown (9). The majority of patients (~63%) were receiving MTX monotherapy but remember this study goes back to 2001 when rheumatologists were practicing this way. The remainder were on combination therapy.

Patients who switched were receiving an average dose of 20 mg/week MTX PO and the average SC dose was 15 mg/week.

To date, 73% of patients remain on SC MTX. The reasons for discontinuation in the other 49 patients include: intolerance (26), adverse drug reaction (10), inefficacy (6), disease remission (2), and unknown (5).

Of those patients who stopped SC MTX, 39% required addition of a biologic agent vs. 28% of those patients who continued SC MTX. This a an improvement of 11% resulting in considerable cost savings.

This evidence again strongly supports the use of SC MTX as a well tolerated and effective therapy.

Continuing with the current treatment paradigm for RA, rheumatologists should consider using SC MTX from the outset. They could also consider "stepping down" to PO MTX in those who respond to and tolerate the therapy.


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Dr. Andy Thompson
Dr. Andy Thompson

Dr. Andy Thompson is an Associate Professor at Western University and founder of Rheuminfo.com, Rheumtalks.com, and RheumReports.com.

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