Background Methotrexate is regarded as an effective and safe disease modifying drug (DMARD). The IM route of administration has been shown to have certain advantages over the oral route. There has been an increase use of IM-Mtx in our department in the last 2 years, leading to increased workload in the nurse-led monitoring clinics and cost.
Objectives To review both the clinical and patient experiences with IM-Mtx, focusing on efficacy and side-effects as well as patient satisfaction.
Methods Medical case-notes of 31 patients, identified from our database, were reviewed. The clinical diagnosis, previous drug therapies, reason for changing to IM-Mtx, efficacy and side-effects were noted. In addition, the patients were asked to complete a questionnaire, looking at patient satisfaction and preferred venue for injections (monitoring clinic or local doctor?s surgery).
Results Our patient cohort was made up of 24 rheumatoid arthritis, 4 seronegative spondyloarthritis, 2 lupus and 1 undifferentiated connective tissue disease. The majority of patients has been on a previous DMARD, including 24 patients on oral Mtx. Reasons for changing to IM-Mtx therapy were as follows: side-effects in 11 patients, loss of efficacy in 12 patients and poor oral compliance in 8 patients. The median starting and maintenance doses were 10 mg weekly (range 5–17.5) and 15 mg weekly (range 10–17.5) respectively.
In the period of study, 5 patients discontinued IM-Mtx; 2 because of side-effects, 1 developed multiple nodulosis, 1 did not attend for follow-up and 1 died from an unrelated cause. Median duration of therapy in the remaining 26 patients was 10 months (range 1–20). Significant improvement in disease activity, as measured by ESR and CRP, was seen after 3 months (p < 0.01), with improvement maintained after 9 months (p < 0.01) of IM-Mtx therapy.
24 of the 26 current patients completed the questionnaire. On a satisfaction scale of 1 to 5, the average rating was 4.2, indicating patients were either very or extremely satisfied with their IM-Mtx therapy. 14 patients preferred their injections in the monitoring clinic, 5 patients preferred their local doctor’s surgery and 5 patients expressed no preferences. Only 3 patients stated that weekly clinic visits were inconvenient.
Conclusion IM-Mtx was found to be effective and well tolerated. It should be considered as an alternative in patients intolerant to other DMARDs, including oral Mtx. Despite weekly clinic visits, patients were either very or extremely satisfied with their therapy. The cost and resource implications of continuing with this therapy need to be addressed.
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