Subcutaneous MTX more effective than Oral MTX | Arthritis Information

Subcutaneous methotrexate produces a significantly greater response in patients with active rheumatoid arthritis than does oral administration of the drug, German researchers report in the January issue of Arthritis and Rheumatism. As such, it appears to be the best choice for monotherapy for the disease.

A group of 384 methotrexate-nave patients with active arthritis were randomized to either oral methotrexate 15 mg/week, given as two 7.5 mg tablets plus a prefilled placebo syringe or to subcutaneous methotrexate in a prefilled syringe containing 10 mg/mL plus two placebo tablets for 24 weeks.

At week 16, patients who did not meet the American College of Rheumatology criteria for 20% improvement (ACR20) were switched from 15 mg to 20 mg oral methotrexate, and from 15 mg to 20 mg subcutaneous methotrexate for the remaining 8 weeks.

The primary outcome was an ACR20 response at 24 weeks, at which point 375 patients were available for follow-up.

Seventy-eight percent of patients treated with subcutaneous methotrexate had an ACR20 response compared with 70% on oral methotrexate. An ACR70 response occurred in 41% of patients on subcutaneous and 33% of patients on oral methotrexate.

Patients with disease duration of at least 12 months had higher ACR20 response rates, at 89% for subcutaneous and 63% for oral administration.

In the ACR20 non-responders, treatment was switched at week 16. Switching from oral to subcutaneous methotrexate resulted in an ACR20 response rate of 30%. Switching from 15 mg to 20 mg of oral methotrexate resulted in an ACR20 response rate of 23%.

Methotrexate was well tolerated, with adverse events occurring at similar rates in both groups.

Lead investigator Dr. J. Braun of Rheumazentrum Ruhrgebiet in Herne, Germany and colleagues conclude that the findings "showed that subcutaneous administration of methotrexate is significantly more effective than oral administration of methotrexate at the same dosage, with no increase in side effects."

"The results of our study support the use of methotrexate as monotherapy in patients with rheumatoid arthritis, being the best of the currently available monotherapies for this condition."

Arthritis Rheum 2008;58:73-81.

Lynn, thanks for this article. Very interesting. I've been thinking about going the injection route, not because I have any problems, but just because I feel like I need more medicine and this would eliminate adding a higher dosage. You're welcome. I thought it was pretty interesting too.Ped rheums recommend injections for children. You know they got the whole dose, it is better absorbed so you can take a lower dose, and it bypasses the stomach for less issues there.

My understanding is all meds go through your liver at some point?

Scarring/site reactions - daughter didn't have that, can't recall posts about that, either.

Odd thing - we saw an adult rheum, who said he would help us locally while our daughter was on mtx. When I got the rx from the ped rheum, the adult rheum told us not to "subject" her to injections! He said to just take the syringe and squirt it in her mouth! Last time we saw him.....

I started inject. MXT about a year ago and after a month saw a difference in how I felt. In fact was able to decrease mg. by 2.5. Have been saying this for the past year that the response from inj. is better than taking it oral. Also, have less side effects. Lindy

I started the injections a few months ago. I didn't have side effects with the pills, I just kept having flares so the doc upped the dose. I still flare, just not as often as I had been.[QUOTE=SnowOwl][

Thanks Suzanne. [/QUOTE]

I think some parents do squirt it in juice? Again, what if they don't drink it all? I don't have enough needle experience to know much about the sizes. I don't think needle size was ever a part of her issues with injections - just the injection itself!

Fear - the reason why we wanted them done at the doctor's office and not at home! I couldn't imagine chasing her around with a needle. She behaves at an office, just cries, knows what's coming. I felt like after it became routine, I would start doing them at the office myself, then we would start doing them at home.

Well, the adult rheum had literally lied, saying he would help us however we needed, then switching and saying not to give her injections. Then the ped's office had to get special permission through the practice mgr., took forever, to do them there. But, in the end, it was the best thing. By phone, the ped rheum's office would say "She needs her shot", no matter what, but when we would get to the ped's office and they could see her, they would confirm she was too sick. Happened more than once before we finally gave up on mtx.