Utilization of Subcutaneous Methotrexate in Rheumatoid Arthritis Patients After Failure or Intolerance to Oral Methotrexate: A Multicenter Cohort Study

Branco, Jaime; Barcelos, Anabela; Araújo, F.; Sequeira, Graça; Cunha, Inês; Patto, José Vaz; Oliveira, Margarida; Mateus, Margarida; Couto, Maura; Nero, Patrícia; Pinto, Patrícia; Monteiro, Paulo; Castelão, Walter; Félix, Jorge; Ferreira, Diana; Almeida, João; Silva, Maria João

doi:10.1007/s12325-015-0276-3

Cited by 26 publications

(16 citation statements)

References 23 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Curtis

Bykerk

Aassi³

et al. 2016

J Rheumatol

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Objective.Medication adherence in patients with rheumatoid arthritis (RA) is typically suboptimal. Nonadherence has been associated with symptom worsening and increased disability. We systematically reviewed published clinical studies to evaluate methotrexate (MTX) adherence and persistence, factors associated with MTX adherence and persistence, and the effect of MTX nonadherence on clinical outcomes in RA.Methods.MEDLINE and Embase were systematically searched (inception to February 2016) using relevant keywords. Observational or interventional clinical studies in patients with RA that specifically reported adherence to or persistence with MTX were included. Data were extracted using a predesigned, standardized template that included study design, patient demographics, and relevant outcomes. Main outcomes were MTX adherence and persistence rates in patients with RA treated with MTX and factors associated with MTX adherence and persistence.Results.Of 365 references screened, 31 articles met inclusion criteria and another 10 were identified from searching reference lists. Estimates of MTX adherence varied from study to study because of heterogeneity in patient populations, duration of followup, definitions of adherence, and methods of assessment. Rates of MTX persistence ranged from 50% to 94% at 1 year and 25% to 79% at 5 years. No clear trends were identified in factors that influence MTX adherence and persistence. Two studies suggested that MTX adherence was associated with superior clinical outcomes.Conclusion.MTX adherence and persistence are highly variable in patients with RA. Research is necessary to determine the effect of nonadherence on health outcomes and to identify independent predictors of nonadherence to inform evidence-based interventions.

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Section: Resultsmentioning

confidence: 99%

“…Persistence with MTX. Twenty-nine studies evaluated persistence with MTX (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 . Most were in the United States and Europe, and 1 each in Israel, India, and Japan.…”

Section: Rheumatologymentioning

confidence: 99%

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

Curtis

Bykerk

Aassi³

et al. 2016

J Rheumatol

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“…It has been reported that subcutaneous use of MTX provides excellent tolerability and compliance with equivalent efficacy to oral treatment. 13 …”

Section: Discussionmentioning

confidence: 99%

Delayed conventional DMARDs therapy is effective in Rheumatoid Arthritis

et al. 2017

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Objective:To determine the disease severity in patients with Rheumatoid Arthritis (RA), at baseline and the impact of treatment on disease activity (DA) after six months of disease modifying anti-rheumatic drugs (DMARDs) therapy.Methods:This prospective study was conducted at the ‘Rheumatology Clinic’ of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from June 2014 to May 2015. A total of 111 patients, with the diagnosis of RA were included in the study. DA was calculated using ‘Clinical Disease Activity Index’ (CDAI) score at base line and after 6 months of DMARDs therapy.Results:Out of 111 patients, 17 (15.3%) were male and 94 (84.7%) were female. The mean age was 37.16±11.3 years and the mean duration of joint pain was 3.8±3.6 years (median 2.5 years). The mean Hb was 10.8±1.8 g/dl and the mean ESR at baseline was 59.63±30.9 mm/Hr. The mean initial CDAI score was 18.14±11.69; reflecting moderate to severe disease. Of all of these patients, 32 (28.8%) patients received monotherapy, 78 (70.3%) received dual therapy and 1(0.9%) was given triple DMARDs therapy. The mean ESR was 39.5±27.31 mm/Hr, and mean CDAI was 7.36±7.8 with a median of 6.0 after 6 months of DMARDs treatment.Conclusion:The CDAI score and the ESR reflected that majority of our patients were in remission or at low disease activity, after six months of DMARDs therapy. It is possible to control DA in RA, in a low resource health care facility with conventional DMARDs therapy. Continuity of treatment was ensured through motivation, regular supply of drugs and regular follow-up.

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“…A synopsis of the most relevant tolerability outcomes observed in clinical studies involving patients with RA and JIA is shown in Table 4 . 27 – 31 , 33 , 35 , 38 – 45…”

Section: Introductionmentioning

confidence: 99%

“…Some retrospective studies have documented relatively high persistence rates of SC MTX treatment, 33 , 38 and this, therefore, may minimize or postpone the need to initiate expensive biological therapy. However, there are controversial data from the real-life experience.…”

Section: Introductionmentioning

confidence: 99%

Update on subcutaneous methotrexate for inflammatory arthritis and psoriasis

Veña¹,

Cassano²,

Iannone³

2018

TCRM

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Methotrexate (MTX) is one of the mainstays of treatment for several immune-mediated inflammatory joint and skin diseases, especially rheumatoid arthritis (RA) and moderate-to-severe psoriasis. Oral MTX has been used for the treatment of such diseases for decades for many reasons. There is, however, a relevant interpatient variability of clinical and safety outcomes that can also be related to differences in patients’ individual pharmacogenomic profile. Orally administered MTX has been found to have a saturable intestinal absorption and nonlinear pharmacokinetics, with significant consequences on drug bioavailability and clinical efficacy. The current evidence shows that parenterally administered MTX results in rapid and complete absorption, higher serum levels, and less variable exposure than oral dosing. The use of parenteral MTX, particularly when administered as a subcutaneous (SC) injection, has recently raised great interest in order to overcome the limitations of oral MTX. The effectiveness and safety of SC MTX have mostly been assessed in rheumatological settings, especially in patients with RA. There are only a limited number of data on SC MTX in juvenile idiopathic arthritis and even fewer in psoriatic disease. Various clinical experiences have suggested that SC MTX is more effective than oral MTX and may provide significant benefit even in patients in whom oral MTX proved to be inadequate. The increased efficacy of SC MTX resulting from higher drug exposure compared with oral MTX has been associated with a similar safety profile and in various reports even with a lower frequency of gastrointestinal complaints. The aim of this article was to review the available literature data on SC MTX treatment of inflammatory arthritis, with special emphasis on RA and psoriasis, examining differences with oral MTX treatment. A brief mention of pharmacokinetics, pharmacodynamic features and pharmacoeconomic considerations is also given.

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Utilization of Subcutaneous Methotrexate in Rheumatoid Arthritis Patients After Failure or Intolerance to Oral Methotrexate: A Multicenter Cohort Study

Cited by 26 publications

References 23 publications

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

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

Delayed conventional DMARDs therapy is effective in Rheumatoid Arthritis

Update on subcutaneous methotrexate for inflammatory arthritis and psoriasis

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