Utilization of Subcutaneous Methotrexate in Rheumatoid Arthritis Patients After Failure or Intolerance to Oral Methotrexate: A Multicenter Cohort Study

Introduction Low-dose weekly methotrexate (MTX) is the mainstay in the therapy of rheumatoid arthritis (RA). It can be given via oral, intramuscular or subcutaneous (SC) route. This study sought to determine the real-world pattern of treatment with SC MTX in Portuguese adult patients with active RA....

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Bibliographic Details
Published in:Advances in therapy 2016-01, Vol.33 (1), p.46-57
Main Authors: Branco, Jaime C., Barcelos, Anabela, de Araújo, Filipe Pombo, Sequeira, Graça, Cunha, Inês, Patto, José Vaz, Oliveira, Margarida, Mateus, Margarida Pratas, Couto, Maura, Nero, Patrícia, Pinto, Patrícia, Monteiro, Paulo, Castelão, Walter, Félix, Jorge, Ferreira, Diana, Almeida, João, Silva, Maria João
Format: Article
Language:English
Subjects:
Adult
Aged
Antirheumatic Agents - administration & dosage
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - drug therapy
Biological Products - therapeutic use
Cardiology
Endocrinology
Female
Follow-Up Studies
Health technology assessment
Humans
Injections, Subcutaneous
Internal Medicine
Male
Medicine
Medicine & Public Health
Methotrexate - administration & dosage
Methotrexate - therapeutic use
Middle Aged
Oncology
Original Research
Pharmacology/Toxicology
Retrospective Studies
Rheumatology
Time Factors
Treatment Outcome
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Summary:Introduction Low-dose weekly methotrexate (MTX) is the mainstay in the therapy of rheumatoid arthritis (RA). It can be given via oral, intramuscular or subcutaneous (SC) route. This study sought to determine the real-world pattern of treatment with SC MTX in Portuguese adult patients with active RA. Methods Utilization of Metoject ® in Rheumatoid Arthritis (UMAR) was a non-interventional, cohort multicenter study with retrospective data collection. Eligible patients had active RA, at least 18 years of age, and started SC MTX treatment in 2009 or 2010 after failure or intolerance to oral MTX. Data were collected from patient’s clinical records. Both non-parametric and parametric survival methods were used to obtain a detailed understanding of SC MTX treatment duration. Result Fifty patients were included, of which only 9 discontinued SC MTX during the study follow-up period. The probability of discontinuation after 1, 2, and 3 years of treatment of SC MTX treatment is expected to be 6.10%, 8.50%, and 23.20%, respectively. The extrapolated median duration of SC MTX using an exponential model was 106.4 months/8.87 years. Mean dose of SC MTX was 18.36 mg. The reasons for treatment discontinuation were occurrence of adverse events in six patients and lack of efficacy in three. Conclusion The long treatment duration of SC MTX highlights its excellent tolerability compared to oral MTX, especially concerning the frequent adverse gastrointestinal events of MTX. Furthermore, long MTX treatment duration provides the opportunity to postpone or even avoid expensive therapies with biologics. The results obtained from the UMAR study provide important information for the utilization and public financing of SC MTX in Portugal.
ISSN:0741-238X
1865-8652
DOI:10.1007/s12325-015-0276-3