SUBCUTANEOUS MTX Is Superior to Oral MTX in RA | Arthritis Information

SAT0129 SUBCUTANEOUS METHOTREXATE IS SUPERIOR TO ORAL METHOTREXATE IN THE TREATMENT OF RHEUMATOID ARTHRITIS.

B. Hameed*¹, H. Jones¹, K. Hunt¹
¹Rheumatology, Kingston Hospital NHS Trust, london, United Kingdom

Background: Methotrexate has been used very successfully in rheumatology practice since the 1950’s. However its gastrointestinal side effects results in reduced patient compliance and subcutaneous methotrexate is tolerated well with good efficacy.
Objectives: To find out if subcutaneous methotrexate is more effective and better tolerated in patients with rheumatoid arthritis previously treated with oral methtrexate.
Methods: 103 patients with rheumatoid arthritis (RA) receiving subcutaneous methotrexate, attending rheumatology outpatients over a 12-month period were included. Data including age, gender, diagnosis, severity of rheumatoid arthritis (Disease activity (DAS) 28 scores, presence of nodules, rheumatoid factor positivity and erosions as shown by plane radiographs) were recorded. The patients were divided in to two groups based on the reason for switching methotrexate from oral to subcutaneous route. Group A comprised of patients for whom the reason for switching was inefficacy of oral methotrexate and group B comprised of patients who were intolerant of oral methotrexate. The DAS 28 scores were recorded before and three months after switching from oral to subcutaneous route of administration. Paired student t-test was used for statistical analysis.

Results: A total of 103 patients were studied. 30 were males and 73 were females. Their mean age was 55 years (range: 20-83 years). In group A, there were 40 patients. 32 patients were positive for rheumatoid factor and 15 had erosive disease on plane radiographs. Their mean DAS 28 score on oral methotrexate was 4.8 and improved to 4.2 with subcutaneous methotrexate (p= 0.006, CI= 0.9-1.03, SD= 1.33). 4 patients achieved remission with subcutaneous methotrexate (DAS28 score < 2.6). In group B, there were 63 patients. 48 were positive for rheumatoid factor, 29 patients had erosive disease on plane radiographs and 3 patients had nodular disease. The majority of the patients (98%) were intolerant to methotrexate from gastrointestinal side effects. Their mean DAS28 score on oral methotrexate was 4.1 and improved to 3.0 with subcutaneous methotrexate (P= 0.0001, CI= 0.9-1.5, SD= 0.9). 15 patients achieved remission with subcutaneous methotrexate and six patients who were in remission with oral methotrexate, maintained remission with subcutaneous methotrexate (DAS 28 score <2.6). At three months there was no dropout with subcutaneous methotrexate.

2. Comparison of the clinical efficacy and safety of subcutaneous versus oral administration of methotrexate in patients with active rheumatoid arthritis: results of a six-month, multicenter, randomized, double-blind, controlled, phase IV trial. Braun J, Kästner P, Flaxenberg P, Währisch J, Hanke P, Demary W, von Hinüber U, Rockwitz K, Heitz W, Pichlmeier U, Guimbal-Schmolck C, Brandt A; MC-MTX.6/RH Study Group. Arthritis Rheum. 2008 Jan;58(1):73-81.

Yes! FWIW, my personal experience is that MTX subcutaneously IS more effective and and effective at lower doses than po (by mouth).

Thanks Lynn, once again your PMS, opps sorry, slip of the keys, your ESP proves invaluable.
[QUOTE=Spelunker]Yes! FWIW, my personal experience is that MTX subcutaneously IS more effective and and effective at lower doses than po (by mouth).

Thanks Lynn, once again your PMS, opps sorry, slip of the keys, your ESP proves invaluable.
[/QUOTE]

My ESP ability is legendary...

I've asked for it... but was told it is not available in my area... that production is down due to the recession..... I will continue to check.... I would prefer it.. though it doesn't bother my stomach too much anymore...

thanks Lynn!!!

Shortage of injectable MTX was a 'problem' in 2007:
[quote=Johns Hopkins]The explanation is a manufacturing problem that apparently will be solved over the next few months. There was a similar problem with injectable solumedrol...[/quote]
Fortunately, I have never had difficulty getting subq MTX from either my local pharmacy or the mail order pharmacy.

Check with your pharmacist, there may be a way to overcome the shortage in your area without too much hassle.

Cheers, Shug
Wow LinB, only 2.5mg?! I wonder if that may be my answer. I was on oral 10mg, and had terrible hair loss as a side effect, plus I couldn't tell any difference in my pain when I was taking it. My RD will probably want me to try it again anyway if he sees erosions on my Sept. MRI. Where do you inject it? I'm not sure I could inject myself.

Jodi, I didn't make myself real clear about decreasing the dosage. I was taking 17.5 mg. and I was able to decrease to 15.0 mg. I decreased by 2.5 mg.

I inject in my thigh. I'm still at 15.0 mg. Fortunately, I've had no negative side effects from MXT. Biotin (spelling) is supposed to help with hair loss. Also, I've read that you reach a plateau and then the hair will grow back. Don't know how much truth is in that statement. Clinical remission is my goal and I'll deal with most side effects if I can stop the damage and complications from RA and PsA. It might be worth a try again if you're not in clinical remission. Keep us posted. Lindy

Bumping for the newbies ttt

bumping for newbies!

Subq works for me. I've never tried it orally so can't compare.

I lost 30lbs from Plaquenil due to diarrhea so when it stopped working suddenly from a flu and RD switched me to Mtx, we avoided the GI tract altogether. I do have a long history of bowel disease including ulcerative colitis so I'm obviously more susceptible to those problems. I take 15mg Mtx weekly.

My dh is in agreement with the inj.being more effective than the oral

I really wish the shots were available to me!!! I will ask again in September.... Babs, before discussing injectable MTX with your physician discuss it with your pharmacist.

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