In a nutshell
This study assessed whether subcutaneous (SC) methotrexate (MTX) was effective in rheumatoid arthritis (RA) patients who suffered side effects from oral MTX, or where oral MTX was ineffective. The study concluded that SC MTX injections were effective and very well tolerated.
Some background
RA is a chronic autoimmune disease (when the immune system attacks healthy tissue) that causes pain, stiffness, swelling, and restricted movement in the joints.
MTX is a standard drug used to treat RA. However, it does not work for all patients. Other patients who find MTX effective can suffer side effects such as diarrhea, gastric intolerance, and vomiting. Usually, if oral MTX fails, patients are switched to other types of drugs.
MTX can be taken orally, via an intramuscular route (injection into the muscle), or subcutaneouusly (injection into the fatty layer under the skin). The effectiveness of SC MTX is unclear.
Methods & findings
In this study, the authors questioned whether SC MTX might be an alternative before switching to other, more expensive, drugs in RA patients who do not respond to, or suffer side effects from, oral MTX.
The records of 50 patients with active RA were reviewed. In each patient, oral MTX was unsuccessful in treating RA (69.57%), or was not tolerated well (28.26%), or both (2.17%). The patients were administered an average dose of 18.36 mg SC MTX. 25 patients had their dose adjusted over time (29.6% reduced, 70.4% increased). Clinical records were reviewed over five years, and the duration of treatment with SC MTX was assessed for all participants.
The typical duration of SC MTX was 8.87 years. Nine patients (18%) discontinued SC MTX during the study, mainly due to side effects.
The bottom line
The study concluded that SC MTX was effective and could potentially reduce GI side effects. It could postpone the use of expensive treatments or drugs resulting in cost savings for the patient and for healthcare systems.
The fine print
This was a small, retrospective study. Longer follow-up periods are recommended for future studies.
What’s next?
If you have problems taking MTX orally, speak to your doctor about other ways to take MTX.
Published By :
Advances in therapy
Date :
Jan 02, 2016
