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

Harris, Emily; Ng, Bernard

doi:10.5152/eurjrheum.2018.17113

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…In our real-life study, MTX monotherapy optimization showed equally effective results on DAS28 and HAQ-DI in almost three-quarters of the patients when compared with bDMARDs initiation ± MTX. Indeed, several studies have shown that MTX optimization is a valuable choice with numerous benefits, potentially avoiding or at least delaying the introduction of costly targeted therapies [ 17 , 18 ]. For instance, the efficacy of MTX dose optimization was recently demonstrated in 314 RA patients from the early arthritis Etude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) cohort receiving MTX as a first DMARD (53%) [mean dose 12.2 (3.8) mg/week].…”

Section: Discussionmentioning

confidence: 99%

“…S.c. MTX has shown improved clinical efficacy [ 19 ], improved bioavailability, especially at doses >15 mg/week [ 20 ], and improved treatment survival, when compared with oral MTX [ 21–23 ]. Moreover, a retrospective cohort study on >7000 patients showed that the use of s.c. MTX, compared with oral, was associated with longer duration of MTX monotherapy before addition/switching to bDMARDs [ 18 ]. Although no randomized controlled trials have yet directly compared s.c. MTX monotherapy vs targeted therapies ± MTX, several observational analyses have shown that the first option was more cost effective for patients and for society as a whole [ 21 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

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MTX optimization or adding bDMARD equally improve disease activity in rheumatoid arthritis: results from the prospective study STRATEGE

et al. 2021

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Objectives The STRATEGE study aimed to describe treatment strategies in current practice in RA bDMARD-naive patients with an inadequate response to MTX therapy, and to compare clinical efficacy of the different therapeutic strategies on disease activity after six months. Methods Main inclusion criteria of this prospective, observational, multicentre study were confirmed RA diagnosis, treatment by MTX monotherapy, and need for therapeutic management modification. Results The 722 patients included had a mean (S.D.) RA duration of 5.3 (6.7) years, a mean DAS28 of 4.0 (±1.1); they were all receiving MTX monotherapy, 68% oral, at a mean dose of 15.0 (4.1) mg/wk. Two major strategies were identified: (i) MTX monotherapy dose and/or route optimization (72%) and (ii) bDMARD initiation ± MTX (16%). MTX dosing was modified for 70% of patients, maintained (dose and route) for 28% of patients, and interrupted for 2%. bDMARDs were started when the MTX mean dose was 17.4 mg/wk, 56% parenterally; MTX was maintained concomitantly for 96% of patients. Six-month follow-up results adjusted by propensity score showed that both options were equally successful in improving disease activity and physical function, with 63% and 68% of good-to-moderate EULAR responses, respectively. Conclusion The STRATEGE study shows the importance of initial MTX treatment optimization before initiation of a biological treatment and emphasizes the importance of treat-to-target strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

MTX optimization or adding bDMARD equally improve disease activity in rheumatoid arthritis: results from the prospective study STRATEGE

et al. 2021

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“…However, data from a randomized controlled trial of 375 MTX-naïve RA patients favoured initiation of 15 mg once weekly MTX therapy by the SC route, which resulted in higher ACR20 and 70 response rates than oral MTX with a similar safety profile at 24 weeks [111]. Furthermore, in a large retrospective cohort study, Harris et al reported that patients taking SC MTX received higher starting and maximum doses than those on oral MTX (>15 mg starting dose and >20 mg maximum dose) [130], perhaps reflecting the better tolerability of the parenterally delivered drug.…”

Section: How To Get the Most Out Of Mtx As A First-line Treatment?mentioning

confidence: 99%

How to Get the Most from Methotrexate (MTX) Treatment for Your Rheumatoid Arthritis Patient?—MTX in the Treat-to-Target Strategy

Taylor

Balsa

et al. 2019

JCM

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Methotrexate (MTX) is a remarkable drug with a key role in the management of rheumatoid arthritis (RA) at every stage of its evolution. Its attributes include good overall efficacy for signs and symptoms, inhibition of structural damage and preservation of function with acceptable and manageable safety, a large dose-titratable range, options for either an oral or parenteral route of administration, and currently unrivalled cost-effectiveness. It has a place as a monotherapy and also as an anchor drug that can be safely used in combination with other conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or used concomitantly with biological DMARDs or targeted synthetic DMARDs. MTX is not without potential issues regarding toxicity, notably hepatotoxicity and bone marrow toxicity, as well as tolerability problems for some, but not all, patients. But many of these issues can be mitigated or managed. In the face of a welcome expansion in available targeted therapies for the treatment of RA, MTX looks set to remain at the foundation of pharmacotherapy for the majority of people living with RA and other inflammatory rheumatic diseases. In this article, we provide an evidence-based discussion as to how to achieve the best outcomes with this versatile drug in the context of a treat-to-target strategy for the management of RA.

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Revisión sistemática del uso de metotrexato por vía parenteral en enfermedades reumáticas

Otón

Carmona

Loza

et al. 2022

Reumatología Clínica

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

Cited by 4 publications

References 25 publications

MTX optimization or adding bDMARD equally improve disease activity in rheumatoid arthritis: results from the prospective study STRATEGE

MTX optimization or adding bDMARD equally improve disease activity in rheumatoid arthritis: results from the prospective study STRATEGE

How to Get the Most from Methotrexate (MTX) Treatment for Your Rheumatoid Arthritis Patient?—MTX in the Treat-to-Target Strategy

Revisión sistemática del uso de metotrexato por vía parenteral en enfermedades reumáticas

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