The comparative effectiveness of oral versus subcutaneous methotrexate for the treatment of early rheumatoid arthritis

Abstract

ObjectiveTo determine the comparative effectiveness of oral versus subcutaneous methotrexate (MTX) as initial therapy for patients with early rheumatoid arthritis (ERA).MethodsPatients with ERA (symptoms ≤1 year) initiating MTX therapy were included from a multicentre, prospective cohort study. We compared the effectiveness between starting with oral versus subcutaneous MTX over the first year. Longitudinal multivariable models, adjusted for potential baseline and time-varying confounders, were used to compare treatment changes due to inefficacy or toxicity and treatment efficacy (Disease Activity Score-28 (DAS-28), DAS-28 remission and Health Assessment Questionnaire-Disability Index (HAQ-DI)).Results666 patients were included (417 oral MTX, 249 subcutaneous MTX). Patients prescribed subcutaneous MTX were prescribed a higher dose of MTX (mean dose over first three months 22.3 mg vs 17.2 mg/week). At 1 year, 49% of patients initially treated with subcutaneous MTX had changed treatment compared with 77% treated with oral MTX. After adjusting for potential confounders, subcutaneous MTX was associated with a lower rate of treatment failure ((HR (95% CI) 0.55 (0.39 to 0.79)). Most treatment failures were due to inefficacy with no difference in failure due to toxicity. In multivariable models, subcutaneous MTX was also associated with lower average DAS-28 scores (mean difference (−0.38 (95% CI −0.64 to −0.10)) and a small difference in DAS-28 remission (OR 1.2 (95% CI 1.1 to 1.3)). There was no significant difference in sustained remission or HAQ-DI (p values 0.43 and 0.75).ConclusionsInitial treatment with subcutaneous MTX was associated with lower rates of treatment changes, no difference in toxicity and some improvements in disease control versus oral MTX over the first year in patients with ERA.

Adherence and Persistence with Methotrexate in Rheumatoid Arthritis: A Systematic Review

“…Interestingly, a claims database analysis of patients with RA initiating MTX found that although about one-half discontinued MTX at 1 year, more than one-third subsequently restarted MTX 52 . One study found patients who received MTX subcutaneously were less likely to add or switch to another nonbiologic DMARD or to add a biologic DMARD than patients treated with oral MTX 57 .…”

Methotrexate in Rheumatoid Arthritis – 2015: New Facts and Ideas

“…Hazlewood и соавт. [143] представили материалы мно-гоцентрового проспективного когортного исследования, включавшего 666 пациентов с ранним РА (длительность <6 мес), из которых 417 получали пероральную форму МТ, а 249 -подкожную. Пациенты, получавшие подкожную форму МТ, в среднем получали более высокую дозу препа-рата (22,3 мг/нед), чем принимавшие МТ перорально (17,2 мг/нед).…”

Methotrexate in Rheumatoid Arthritis – 2015: New Facts and Ideas

“…Hazlewood и соавт. [142] представили материалы мно-гоцентрового проспективного когортного исследования, включавшего 666 пациентов с ранним РА (длительность <6 мес), из которых 417 получали пероральную форму МТ, а 249 -подкожную. Пациенты, получавшие подкожную форму МТ, в среднем получали более высокую дозу препа-рата (22,3 мг/нед), чем принимавшие МТ перорально (17,2 мг/нед).…”