Objectives To evaluate comparative efficacy of injection and tablet methotrexate forms in rheumatoid arthritis treatment.
Methods 23 patients were included in study group (19 women, 4 men) with moderate (47.8%) and high activity (52.2%), receiving methotrexate subcutaneously in a dose of 10 -15 mg (average dose - 11 1±5,21) 1 time per week: 11 patients were switched from methotrexate tablet form, 2 patients received leflunomide previously, 10 patients received methotrexate initially. Comparison group - 20 patients (17 women, 3 men) taking methotrexate (10 -15 mg/week, the average dose 11,6±4,89) in tablets. The groups were comparable on key parameters. Effectiveness evaluation (ACR and EULAR criteria) and tolerability of treatment was carried out every 4 weeks for 6 months.
Results Significant clinical and laboratory improvement (ACR 20) was achieved in 23 patients (main group) and in 14 patients - the control group. The appearance of the first effect (ACR 20) of methotrexate subcutaneously was observed after 2 weeks of treatment in 8 (34.8%), one month therapy - 17 (73.9%) patients, in the control group at 2 weeks - in 1 (5%), after 1 month at 7 (5%) patients respectively. After 6 months of methotrexate subcutaneously treatment decrease in activity (DDAS28ESR 2,3±0,9, initial DAS28ESR 5,3±2,9) corresponds to good effect, and treatment was significantly (p<0.05) better compared to the group receiving methotrexate in tablet form (DDAS28ESR 1,3±1,0, initial DAS28ESR 5,2±2,6). Adverse events occurred in 5 (21.7%) patients of the main group (alopecia, itching at the injection site, increased transaminases less than 1.5 normal) did not require discontinuation of the drug, in the control group - in 11 (55%) patients: dyspepsia, alopecia, increased transaminases, 2 (10%) patients refused from therapy
Conclusions Subcutaneous administration of methotrexate in RA patients demonstrated more rapid and pronounced effect, better tolerability compared with taking the drug inside.
Disclosure of Interest None declared