Effectiveness and tolerability of oral vs subcutaneous methotrexate in patients with rheumatoid arthritis

被引:5
|
作者
Heuvelmans, Janne [1 ]
den Broeder, Nathan [1 ]
van den Elsen, Geke A. H. [2 ]
den Broeder, Alfons A. [1 ,3 ]
van den Bemt, Bart J. F. [4 ,5 ]
机构
[1] Sint Maartensklin, Dept Rheumatol, Nijmegen, Netherlands
[2] Radboud Univ Nijmegen Med Ctr, Dept Pharmacol & Toxicol, Nijmegen, Netherlands
[3] Radboud Univ Nijmegen Med Ctr, Dept Rheumatol, Nijmegen, Netherlands
[4] Sint Maartensklin, Dept Pharm, Nijmegen, Netherlands
[5] Radboud Univ Nijmegen Med Ctr, Dept Pharm, Nijmegen, Netherlands
关键词
methotrexate; rheumatoid arthritis; route of administration; oral; subcutaneous; split dosing; BIOAVAILABILITY; EFFICACY; SAFETY;
D O I
10.1093/rheumatology/keab313
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives The aim of this study was to compare the effectiveness and tolerability between oral MTX and s.c. MTX in a large group of RA patients in a real-life setting. Methods In this retrospective cohort study, adult patients with clinical diagnosis of RA who started MTX treatment (monotherapy or combined with HCQ) started with either oral or s.c. MTX. The primary outcome was superiority testing of between group difference in change in DAS28CRP between baseline and 3-6 months, and subsequent non-inferiority (non-inferiority margin 0.6) testing analyses in case of non-superiority. Secondary outcomes included MTX dose, side effects, laboratory abnormalities and use of comedication. Results Six hundred and forty RA patients were included: 259 started with oral MTX and 381 with s.c. MTX. There was no significant difference in Delta DAS28CRP [after adjusting for confounding, 0.13 (95% CI: -0.14, 0.40)], and oral MTX strategy was non-inferior to s.c. The mean MTX dose was slightly lower for the oral strategy [18.0 (6.9) vs 19.9 (8.2), P = 0.002], which was accompanied by a lower cumulative incidence of adverse events (41% vs 52%, P = 0.005). No differences were seen in use of other comedication. Conclusion Starting with oral MTX in RA in a real-life setting is non-inferior to a s.c. MTX treatment with regard to disease activity control, at least when used in dosages up to 25 mg and on a background of HCQ co-treatment and a treat-to-target approach. In addition, tolerability was better. This supports the strategy of starting with oral MTX.
引用
收藏
页码:331 / 336
页数:6
相关论文
共 50 条
  • [21] EFFECTIVENESS OF SUBCUTANEOUS PRESENTATION OF METHOTREXATE IN PATIENTS WITH RHEUMATOID ARTRHITIS
    Villarreal, L.
    Rivero, M.
    Buitrago-Garcia, D.
    Cabrera, M.
    Santos-Moreno, P.
    ANNALS OF THE RHEUMATIC DISEASES, 2018, 77 : 1407 - 1407
  • [22] Pharmacokinetics of Oral Methotrexate in Patients With Rheumatoid Arthritis
    Dalrymple, Judith M.
    Stamp, Lisa K.
    O'Donnell, John L.
    Chapman, Peter T.
    Zhang, Mei
    Barclay, Murray L.
    ARTHRITIS AND RHEUMATISM, 2008, 58 (11): : 3299 - 3308
  • [23] ORAL EFFECTS OF METHOTREXATE IN PATIENTS WITH RHEUMATOID ARTHRITIS
    Nerbon Burguera, O.
    Guillen Salazar, I
    BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY, 2015, 117 : 5 - 5
  • [24] Effectiveness, Tolerability, and Safety of Subcutaneous Methotrexate in Early Rheumatoid Arthritis: Clinical Data from the St. Gallen Cohort
    Mueller, Ruediger
    von Kempis, Johannes
    Schiff, Michael H.
    Haile, Sarah
    ARTHRITIS & RHEUMATOLOGY, 2014, 66 : S1030 - S1030
  • [25] Utilization of Subcutaneous Methotrexate in Rheumatoid Arthritis Patients After Failure or Intolerance to Oral Methotrexate: A Multicenter Cohort Study
    Branco, Jaime C.
    Barcelos, Anabela
    de Araujo, Filipe Pombo
    Sequeira, Graca
    Cunha, Ines
    Patto, Jose Vaz
    Oliveira, Margarida
    Mateus, Margarida Pratas
    Couto, Maura
    Nero, Patricia
    Pinto, Patricia
    Monteiro, Paulo
    Castelao, Walter
    Felix, Jorge
    Ferreira, Diana
    Almeida, Joao
    Silva, Maria Joao
    ADVANCES IN THERAPY, 2016, 33 (01) : 46 - 57
  • [26] Utilization of Subcutaneous Methotrexate in Rheumatoid Arthritis Patients After Failure or Intolerance to Oral Methotrexate: A Multicenter Cohort Study
    Jaime C. Branco
    Anabela Barcelos
    Filipe Pombo de Araújo
    Graça Sequeira
    Inês Cunha
    José Vaz Patto
    Margarida Oliveira
    Margarida Pratas Mateus
    Maura Couto
    Patrícia Nero
    Patrícia Pinto
    Paulo Monteiro
    Walter Castelão
    Jorge Félix
    Diana Ferreira
    João Almeida
    Maria João Silva
    Advances in Therapy, 2016, 33 : 46 - 57
  • [27] EFFECTIVENESS, TOLERABILITY, AND SAFETY OF SUBCUTANEOUS METHOTREXATE IN EARLY RHEUMATOID ARTHRITIS: CLINICAL DATA FROM THE ST. GALLEN COHORT
    Mueller, R.
    Schiff, M. H.
    Haile, S. R.
    Von Kempis, J.
    ANNALS OF THE RHEUMATIC DISEASES, 2014, 73 : 227 - 227
  • [28] Patient's experience with subcutaneous and oral methotrexate for the treatment of rheumatoid arthritis
    Curtis, J. R.
    Xie, F.
    Mackey, D.
    Gerber, N.
    Bharat, A.
    Beukelman, T.
    Saag, K. G.
    Chen, L.
    Nowell, B.
    Ginsberg, S.
    BMC MUSCULOSKELETAL DISORDERS, 2016, 17
  • [29] Patient’s experience with subcutaneous and oral methotrexate for the treatment of rheumatoid arthritis
    J. R. Curtis
    F. Xie
    D. Mackey
    N. Gerber
    A. Bharat
    T. Beukelman
    K. G. Saag
    L. Chen
    B. Nowell
    S. Ginsberg
    BMC Musculoskeletal Disorders, 17
  • [30] Comparison of subcutaneous and oral methotrexate initiation in rheumatoid arthritis in current practice
    Vidal-Montal, Paola
    Thomas, Marion
    Combier, Alice
    Steelandt, Alexia
    Miceli-Richard, Corinne
    Molto, Anna
    Narvaez, Javier
    Nolla, Joan Miquel
    Allanore, Yannick
    Avouac, Jerome
    JOINT BONE SPINE, 2023, 90 (06)