Background Methotrexate (Mtx) should be the drug of the first choice in rheumatoid arthritis (RA) if there are no contraindications to use it. The efficacy of Mtx is measured by remission or low disease activity and depends on the dose taken. Higher doses (25–30 mg/week) are more effective, but intolerance is the main cause of discontinuation of oral treatment. Subcutaneous Mtx is efficient alternative in those cases.
Objectives The aim of this study was to evaluate subcutaneous Mtx use frequency in Polish patients and change oral form for subcutaneous as well.
Methods The disease activity was assessed by Disease Activity Score 28 (DAS 28) during the first visit (V1) and after 3 months therapy (V2) and compliance with therapy as well.
Results There were 194 RA patients diagnosed by the ACR and 1997 and/or ACR/EULAR 2010 criteria. 144 patients were treated by oral Mtx (group A) and 50 patients (group B) by subcutaneous Mtx at the time of study enrolment (V1).37 patients of group A (26%) required changes in therapy during V2, 24 (17%) were switched to subcutaneous Mtx (group A1). 6 patients of group B (12%) required change of treatment during V2, including 2 patients (4%) with subcutaneous Mtx, who were switched to oral Mtx.The main cause of changing therapy from oral to subcutaneous was gastrointestinal intolerance of high dose of Mtx. 69 patients (12%) of group A required additional steroid therapy compared to 18 (36%) of group B. Average DAS 28 decreased by 0.58 in group A1 in oral treatment and during the subcutaneous treatment time decreased by next 0.23. In group A1 during oral treatment 14 (58%) patients used 25 mg/week and 20 patients (83%) used 25 mg/week during subcutaneous treatment time.
Conclusions Patients treatment by oral Mtx often require modification of therapy in comparison to patients treated by subcutaneous Mtx, including more frequent use of steroids
The main cause of oral intolerance are ailments of the digestive system.
Change of oral to subcutaneous therapy allows administration of higher doses of Mtx and results in decrease of DAS28 in comparison to the patients continuing their oral treatment.
Disclosure of Interest None declared