In a nutshell
The authors examined the patterns of use of methotrexate: dose administered, method of administration, and duration of treatment.
Some background
Methotrexate (MTX) is the most commonly used medication for the treatment of rheumatoid arthritis and is the first treatment recommended for newly diagnosed patients. It can be given orally, by injection into the skin (subcutaneous), or by injection into muscles (intramuscular).
Research suggests that for optimal disease management methotrexate should initially be used at 15mg/week and increased to 25-30mg/week, then switched to skin injections. Despite the widespread use of methotrexate there is little research into its real world use in newly diagnosed patients.
Methods & findings
Two groups of newly diagnosed patients were examined: group one had a commercial health insurance (4,048 patients) and group two had Medicare plans (20,406 patients). Patients were followed-up for an average of 2.4 to 2.6 years.
Patients in Medicare and patients with commercial insurance received similar average starting dose (13.1 to 13.6mg/week) and peak doses of methotrexate. Over 50% of patients used doses of more than 20 mg/week at some point during the follow-up. After one year of treatment over 50% of patients had stopped using methotrexate. However, 37% of Medicare patients and 41% of commercial insurance patients restarted methotrexate within 12 months of stopping.
A greater percentage of patients with commercial insurance changed their treatment plan to also include a biologic medication (most commonly anti-TNF medication): 35.3% versus only 19% of Medicare patients. Less than 5% of patients switched from oral methotrexate to skin injections.
The bottom line
The authors concluded that increasing to higher doses of oral methotrexate and switching to injections of methotrexate into the skin is infrequent and may be underutilized in the real world setting.
Published By :
Arthritis Care & Research
Date :
Jun 18, 2014
