Use of Oral and Subcutaneous Methotrexate in Rheumatoid Arthritis Patients in the United States

Abstract

Objective. To examine the patterns of methotrexate (MTX) use among rheumatoid arthritis (RA) patients. Methods. Using data from RA patients enrolled in a US commercial health plan and the US Medicare program, we identified RA patients initiating oral MTX. Persistence with MTX (oral or subcutaneous [SC]) was defined as no gap for >90 days. Results. New oral MTX users in Medicare (n ‫؍‬ 20,431) were 76.9% women, had a mean ؎ SD age of 69.7 ؎ 11.7 years, and contributed a median followup of 2.6 years (interquartile range 1.7-3.5 years). Only 38% received dosages >20 mg/week at any time. Approximately 50% of patients discontinued MTX at 1 year, although more than one-third of patients subsequently restarted. New commercially insured oral MTX users (n ‫؍‬ 4,048) were similar to Medicare patients, except for age. Among Medicare patients, 19% starting oral MTX subsequently initiated a biologic agent, mostly anti-tumor necrosis factor (85%). Of these, only 50% received MTX at a dosage of >20 mg/week, and only 21% of individuals switched to SC MTX (4%) or received hydroxychloroquine (8%), sulfasalazine (5%), or leflunomide (8%) prior to biologic agents. In commercially insured patients, 35% initiated a biologic agent, mostly anti-tumor necrosis factor therapies (90%). Of these, 43% never received MTX >20 mg/week. Conclusion. Titration to a higher-dose oral MTX and use of SC MTX among RA patients were infrequent and may have been underutilized. Further work to optimize MTX dosing before patients are switched to a biologic agent may be warranted.

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

“…For each study, data were extracted and quality was assessed. Results are summarized in Table 1 9,11,12,19,20,21,22,23,24,25,26,27 , Table 2, Table 3 [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]48,49,50,51,52,53,54,55,56 , and Table 4, as well as Supplementary Table 2 and Supplementary Table 3 (available online at jrheum.org). MTX adherence.…”

Project: Recommendations on Treatment of Rheumatoid Arthritis Developed by All-Russian Public Organization «association of Rheumatologists of Russia» – 2014 (Part 1)

“…Так, по данным J.R. Curtis и соавт. [287], в США только около половины больных, которым инициировалось лечение ГИБП, принимали МТ в адекватных дозах (>15 мг/нед) и менее 5% -подкожную форму МТ. Полагают, что именно оптимизация лечения МТ, в первую очередь бо-лее широкое применение подкожной формы МТ, позво-лит существенно улучшить результаты лечения РА [287,288] и снизить стоимость терапии за счет уменьшения потребности в назначении дорогостоящих ГИБП [150].…”

“…[287], в США только около половины больных, которым инициировалось лечение ГИБП, принимали МТ в адекватных дозах (>15 мг/нед) и менее 5% -подкожную форму МТ. Полагают, что именно оптимизация лечения МТ, в первую очередь бо-лее широкое применение подкожной формы МТ, позво-лит существенно улучшить результаты лечения РА [287,288] и снизить стоимость терапии за счет уменьшения потребности в назначении дорогостоящих ГИБП [150]. Это особенно важно в свете данных американского реги-стра CORRONA (CОnsortium of Rheumatology Researchers Оf North America), материалы которого продемонстриро-вали высокую частоту прерывания лечения ГИБП (инги-биторы ФНОα и препараты с другим механизмом дейст-вия) при РА из-за снижения эффективности терапии [289], что в определенной степени может быть связано с применением неадекватных доз МТ.…”

Using subcutaneous methotrexate to prolong duration of methotrexate therapy in rheumatoid arthritis

“…This is consistent with findings of other analyses, which also showed increased therapeutic benefit and retention with SC MTX when compared to oral MTX (16). It also suggests that the use of SC MTX may allow patients to maintain good disease control with MTX monotherapy for a longer period of time before adding other DMARDs or expensive biologic agents and that it may be an effective treatment strategy, as suggested by others (17). We found that patients on SC MTX monotherapy were taking higher doses of MTX than those on oral therapy, and it has been shown that higher doses of MTX are associated with longer duration of MTX therapy (3).…”