Background Methotrexate (MTX) is the cornerstone of rheumatoid arthritis (RA) therapy, but many patients do not achieve adequate response to oral therapy for reasons of tolerability or efficacy.1,2 Subcutaneous (SC) MTX should be considered for RA patients who have an unsatisfactory response to oral MTX.3
Objectives In this analysis, RA patients switched from oral MTX to SC MTX monotherapy were evaluated to understand durability of response and disease control.
Methods A retrospective analysis of RA patient data collected from 2003 to 2011 at a single site in the United Kingdom4 was performed. Per institutional practice, incremental oral MTX dose increase was followed by a switch to SC MTX. Folic acid (5-15 mg) was given 1 day after SC MTX treatment as a matter of routine practice. Mean duration on SC MTX monotherapy following switch from oral MTX was documented via patient record review.
Results One hundred twelve RA patients were eligible for analysis. Mean age was 60.9 years (range, 26-83 y), and mean disease duration was 8.3 years (range, 0.5-46 y). 49 (44%) patients with an inadequate response to oral MTX for reasons of tolerability or efficacy were switched to SC MTX monotherapy and included in this analysis (Table). Twenty patients (41%) switched from oral MTX to SC MTX for reasons of tolerability. Among these patients, mean DAS28 improved by 1.05, patients remained on SC MTX monotherapy for a mean of 28.6 months before additional treatment was added, and 40% (8) achieved low disease activity (LDA) of DAS28 ≤3.2. Twenty-nine patients (59%) switched for reasons of efficacy. Among these patients, mean DAS28 scores improved by 1.26, patients remained on SC MTX monotherapy for a mean of 34.58 months before addition of other therapies, and 24% (7) achieved LDA.
Conclusions In this single-center analysis, RA patients with an inadequate response to oral MTX for reasons of efficacy and/or tolerability maintained satisfactory disease control and durable, long-term response when switched to SC MTX monotherapy.
Salliot C, van der Heijde D. Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann Rheum Dis. 2009;68:1100-1104.
Visser K, van der Heijde D. Optimal dosage and route of administration of methotrexate in rheumatoid arthritis: a systematic review of the literature. Ann Rheum Dis. 2009;68:1094-1099.
Hameed B, Jones H. Subcutaneous methotrexate is well tolerated and superior to oral methotrexate in the treatment of rheumatoid arthritis. Int J Rheum Dis. 2010;13:e83-e84.
Liakos A, et al. Ann Rheum Dis. 2012;71:672.
Disclosure of Interest : None declared
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