Background Methotrexate (MTX) is an anchor drug in the treatment of patients with rheumatoid arthritis (RA) but gastrointestinal side effects of oral route may restrict its use in most of the patients (1).
Objectives The aim of this study was to evaluate if subcutaneous MTX is more effective in a group of patients with RA, previously received oral methotrexate and switched to sc MTX, due to side effects and/or inefficacy of oral form.
Methods Eigthy patients recruited from the Rheumatology unit of a tertier Education and Research Hospital, were included to the study. The patients were only on MTX therapy as disease modifying agent but some of them were on low dose steroid or NSAI drugs. Demographic data, including age, gender, disease duration, and disease activity parameters comprising DAS28, ESR, CRP, RF, pain by VAS, as well as number of patients with gastrointestinal (GIS) side effects due to MTX treatment were recorded. The parameters were determined for the last visit of oral MTX, and 1st and 3rd month visit after subcutaneous MTX (Table 1).
Results Sixty-eight female and 12 male patients with a mean age of 54.06±1.4 years were recruited to the study. The mean disease duration and oral MTX duration were 122.5±96.8 months and 52.01±45.1 months respectively. There were 76 patients with GIS side effects. All of the disease activity parameters including DAS28, ESR, CRP, pain by VAS were decreased at 1st and 3th month visits after the subcutaneous therapy (Table 1). The number of patients with GIS side effects, were also decreased in the first (n=30, p<0.05) and third month visits (n=27, p<0.05). No statistically significant difference was observed in RF levels before and after subcutaneous MTX therapy (p>0.05). At 3rd month visit, there was no drop out with subcutaneous MTX.
Conclusions In conclusion subcutaneous MTX has better efficacy in regard to disease activity and better tolerability than in oral forms, if there is inefficacy or intolerability due to GIS side effects.
Yazici Y, Bata Y. Bull Hosp Jt Dis 2013;71(Suppl 1):46-8.
Disclosure of Interest None declared