Background Methotrexate (MTX) is one of the most used drugs for the treatment of rheumatoid arthritis (RA) and has become the gold standard of therapy. It can be given via oral, intramuscular or subcutaneous (SC). MTX is a highly effective therapy for patients with RA; however, oral MTX has been associated with gastrointestinal intolerance diminishing the adherence of patients to treatment and increasing the switching to biological therapy. Thus, the use of SC methotrexate can improve its efficacy compared to oral MTX.

Objectives The aim was to determine the effectiveness and safety of SC MTX in patients with rheumatoid arthritis.

Methods We performed a retrospective descriptive analysis; our main goal was to provide real-life data regarding effectiveness of SC MTX in patients with RA. We excluded patients who were in remission. Clinical follow-up was designed by the authors according to DAS28 as follows: every 3–5 weeks (DAS28 >5.1), every 7–9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11–13 weeks (DAS28 <3.1). Tender joint count (TJC), swollen joint count (SJC) and DAS28 were measured on each visit. Therapy had to be adjusted with DAS28 >3.2 unless patient’s conditions don’t permit it; regarding the effectiveness of SC MTX we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We performed a bivariate analysis using Pearson’s chi²

Results A total of 132 patients meet our inclusion criteria, 88% were female and 12% male. Mean age was 61 years±9. Mean DAS28 at baseline was 3.8±0.83, while at 12 months mean DAS28 was 3.28±1.12. Clinical disease activity CDAI at baseline had a mean of 9.6±7.2 and at 12 months 7.8±7.5. We achieved remission in 33% of patients according to DAS28% and 29% according to CDAI, also it was a significant decrease in patients with moderate disease activity see table 1. Finally, there was a statistical significance between disease activity at baseline compared to disease activity at 12 months (p<0.005). It was not observed major complaints with SC MTX, only 5% of the patients reported some mild and transient discomfort at the local application site.

Conclusions Subcutaneous MXT is an effective and safe alternative for the treatment in patients with RA and intolerance to oral MTX, and could be a good option to prevent a premature switching to biological therapy.

Disclosure of Interest None declared