Recomendaciones sobre el uso de metrotexato parenteral en enfermedades reumáticas

Molina, Jesús Tornero; Alén, Jaime Calvo; Ballina, Javier; Belmonte, María Ángeles; Blanco, Francisco J.; Caracuel, Miguel A.; Carbonell, Jordi; Corominas, Hèctor; Chamizo, E.; Hidalgo, Cristina; Ivorra, José Román; Marenco, José Luis; Muelas, José Vicente Moreno; Nolla, Joan M.; Pérez, Trinidad; Sanmarti, Raimón; Trénor, Pilar; Urrego, Claudia; Vidal, Julie

doi:10.1016/j.reuma.2016.12.001

Cited by 14 publications

(6 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…29 However, MTX given orally shows a lower absorption and a worse safety profile regarding gastrointestinal toxicity that may justify the switch to SC MTX instead to biologics. [16][17][18][19][20]22,27 Likewise, as we have previously mentioned, based on the expert consensus document by Tornero-Molina et al, and should being re-evaluated periodically, in situations where initial doses are necessary as in overweight patients, the switch from oral MTX to SC MTX is also recommended. 17 In support of this, evidence has demonstrated that SC MTX both as initial therapy in naive patients 20,26 or subsequent therapy in non-responder patients improves treatment persistence, and clinical efficacy mainly due to its favorable bioavailability, 30 and optimizes the use of healthcare resources.…”

Section: Methotrexate In Rheumatoid Arthritismentioning

confidence: 98%

“…In some cases, the use of parenteral route should be considered to overcome the limitations of oral administration of MTX. A recent article by Tornero Molina et al, 16 for the use of parenteral MTX in rheumatic diseases, mainly RA, and based on best evidence and experience in order to solve frequent questions and help in decision-making strategies, indicated that patients with an inadequate response to oral MTX (15 mg/week), escalating the dose utilizing the parenteral route is clinically more effective. The use of parenteral MTX is recommended to be also considered in patients with highly active disease, poor adherence to oral treatment, taking multiple drugs, or obesity.…”

Section: Methotrexate In Rheumatoid Arthritismentioning

confidence: 99%

“…The use of parenteral MTX is recommended to be also considered in patients with highly active disease, poor adherence to oral treatment, taking multiple drugs, or obesity. 16 Additionally, considering the expert consensus document by Tornero-Molina et al, in RA patient's refractory or intolerant to oral MTX and even poor-adherents, the switch to SC MTX is recommended before introducing a biologic agent. 17 The assessment of effectiveness and safety of SC MTX has been mainly focused on RA and evidence highlights the superior clinical efficacy of SC MTX over oral MTX.…”

Section: Methotrexate In Rheumatoid Arthritismentioning

confidence: 99%

“…[1][2][3][4][9][10][11] Treatment adherence in RA has been extensively investigated and reviewed in several metaanalyses [12][13][14][15] that show suboptimal compliance, especially to the reference therapy methotrexate (MTX). The subcutaneous (SC) formulation of MTX, unlike the oral delivery, is the best option in pursuing a higher efficacy and better tolerability; but while the route of administration does not appear to influence drug adherence in RA, 14,[16][17][18][19][20][21][22] some difficulties associated with syringe use may difficult the use of the SC delivery. Therefore, to avoid the problems in administering self-injections using the classic syringes from reduced manual dexterity patients with RA, new drug-delivery devices have been developed that facilitate the use and reduce the discomfort.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Potential Benefits of the Self-Administration of Subcutaneous Methotrexate with Autoinjector Devices for Patients: A Review

Molina¹,

Robledillo²,

Ruiz³

2021

DHPS

Self Cite

View full text Add to dashboard Cite

The role of patient adherence in improving the efficacy of any treatment is widely accepted, as well as its impact in optimizing the use of healthcare resources and associated costs. Adherence is particularly affected in chronic conditions, such as rheumatoid arthritis (RA), requiring long-term therapies and a commitment of the patient to manage his/her disease. Methotrexate (MTX) is one of the mainstays of treatment for several immunemediated inflammatory joint and skin diseases, especially RA. The use of parenteral MTX, particularly when administered as a subcutaneous (SC) injection, has recently raised a great interest to overcome the limitations of oral MTX. For addressing this issue, new optimized self-injection systems have been developed to improve the ease of use of SC MTX. Increasing evidence shows how patients tend to opt for autoinjectors over prefilled syringes or conventional syringes in terms of easiness of use, preference and satisfaction, regardless of whether the treatment is a biologic or MTX. Additionally, positive views and beliefs of patients about treatment may contribute to increasing expectations of effectiveness and treatment adherence. Similarly, the implementation of prefilled pens in clinical practice might be a way to facilitate and simplify the self-injection of SC MTX delivery, optimizing adherence and treatment outcomes as a consequence. This article aimed to review the available literature data on the use of MTX autoinjectors and their impact on treatment adherence and patients' perceptions.

show abstract

Section: Methotrexate In Rheumatoid Arthritismentioning

confidence: 98%

Section: Methotrexate In Rheumatoid Arthritismentioning

confidence: 99%

Section: Methotrexate In Rheumatoid Arthritismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Potential Benefits of the Self-Administration of Subcutaneous Methotrexate with Autoinjector Devices for Patients: A Review

Molina¹,

Robledillo²,

Ruiz³

2021

DHPS

Self Cite

View full text Add to dashboard Cite

show abstract

“…Согласно российским и зарубежным клиническим рекомендациям [13][14][15][16], лечение МТ следует начинать с дозы 10-15 мг/нед с быстрым ее увеличением (на 2,5-5 мг каждые 2-4 нед) до 25-30 мг/нед в зависимости от эффективности и переносимости. После 24 нед терапии у больных старшей возрастной группы концентрация МТПГ4 была ниже, а уровень исходной моноглутаматной формы МТ -выше, чем у остальных пациентов, что подтверждает данные о более медленном метаболизме МТ и оправдывает более продолжительный интервал ожидания терапевтического эффекта МТ в пожилом возрасте.…”

unclassified

Therapeutic drug monitoring of methotrexate and its metabolites in the red blood cells and mononuclear cells of patients with rheumatoid arthritis

Гриднева¹,

Муравьев²,

Баймеева³

et al. 2020

Sovremennaâ revmatologiâ

View full text Add to dashboard Cite

Objective: to assess the time course of changes in the concentration of methotrexate (MTX) and its main metabolites in the red blood cells (RBC) and mononuclear cells (MNC) of patients with rheumatoid arthritis (RA), by taking into account individual characteristics (age, statin therapy, and smoking).Patients and methods. The investigation enrolled 33 MTX-treated patients (mean age 53.2±11.7 years) with RA, who underwent therapeutic drug monitoring to measure the RBC and MNC concentrations of free MTX and MTX polyglutamates (MTXPGs) with 2, 3, and 4 glutamate residues (MTXPG 2–4) in using tandem chromatomass spectrometry after 4, 12, and 24 weeks of therapy.Results and discussion. Following 12 weeks, the concentration of MTXPG4 in the MNC was higher in patients taking statins, while that of MTX and MTXPG2 in the RBC were significantly lower than in smokers. At 24 weeks, older patients were observed to have a higher MTX level and a lower MTXPG4 concentration in the RBC.Conclusion. After 24 weeks of therapy, the RBC concentration of MTPG4 was lower and that of MTX was higher in older patients than in others, which confirms data on a slower MTX metabolism in the elderly. The use of statins is likely to have a positive impact on the accumulation of MTXPG. There is a statistically significantly lower RBC concentration of MTXPG in at 12 weeks of therapy.

show abstract

Barriers and Enablers in the Use of Parenteral Methotrexate in Rheumatoid Arthritis Patients: A Scoping Review

Tan

Reeve

Fraser

et al. 2023

Arthritis Care & Research

View full text Add to dashboard Cite

ObjectiveMethotrexate (MTX) is effective in controlling disease activity in rheumatoid arthritis (RA). Parenteral MTX may have benefits over oral MTX, but it is rarely used in practice. To better understand this low usage rate, it is necessary to explore the barriers and enablers of therapy from the perspective of RA patients. The objectives of this scoping review were to describe RA patients’ perspectives on the barriers and enablers in the use of parenteral MTX and to identify the research gaps in this field.MethodsThe search was performed in Medline, Embase, Scopus, and Cochrane Library from inception to May 2021. Data synthesis was conducted using the Theoretical Framework of Acceptability. This scoping review included any type of study that explored the use of parenteral MTX by adult RA patients from the patients’ perspective, written in English.ResultsFifteen studies were included; findings related to the constructs “affective attitude,” “burden,” “intervention coherence,” and “self‐efficacy” were explored the most, while some were rarely (“opportunity cost” and “perceived effectiveness”) or not (“ethicality”) reported. RA patients were generally satisfied with MTX injections (“affective attitude”). From the burden construct, the requirement for dexterity for administering MTX by injection was considered a barrier, whereas the lack of significant pain from MTX injection was considered an enabler.ConclusionThe findings suggested that patients generally preferred parenteral MTX formulations with attributes that facilitate self‐administration. However, much of the identified research focused on prefilled pen devices, and significant gaps were identified, such as a lack of qualitative research.image

show abstract

Recomendaciones sobre el uso de metrotexato parenteral en enfermedades reumáticas

Cited by 14 publications

References 41 publications

Potential Benefits of the Self-Administration of Subcutaneous Methotrexate with Autoinjector Devices for Patients: A Review

Potential Benefits of the Self-Administration of Subcutaneous Methotrexate with Autoinjector Devices for Patients: A Review

Therapeutic drug monitoring of methotrexate and its metabolites in the red blood cells and mononuclear cells of patients with rheumatoid arthritis

Barriers and Enablers in the Use of Parenteral Methotrexate in Rheumatoid Arthritis Patients: A Scoping Review

Contact Info

Product

Resources

About