SAT0235 Subcutaneous methotrexate is safer and more effective than oral methotrexate alone and in combination. (12th June 2018)

• Record Type: Journal Article
• Authors: Li, K. H. C.; Jones, T.; Grove, M.; Roberts, A.; Birrell, F.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 978
• Page End: 979
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.7556
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Methotrexate (MTX) is established as both first line therapy and combination therapy anchor drug for Rheumatoid Arthritis (RA) and other peripheral inflammatory arthritis such as Psoriatic Arthritis (PsA). There is evidence subcutaneous (sc) MTX is more effective than oral MTX, with fewer treatment failures 1–3, but it is not known if this holds true in routine practice and in combination. Objectives: To show the safety & efficacy of sc MTX therapy in routine practice, compared to oral MTX, alternate monotherapy and combination therapies. Methods: The Therapy Audit Monitoring System (TAMS, www.therapyaudit.com/tamonitor) was installed Jan 2014. Since then all new patients starting disease modifying therapy and existing patients are entered. The database was queried for diagnosis, dose and response, together with adverse events (defined as ALT>80U/l or neutrophils<2.0x10 9 /l). Statistical comparisons used the two proportion Z test, T-test or exact rate ratio test, as appropriate: significance threshold p<0.05. Results: Conclusions: sc MTX is safe and effective in routine practice at doses up to 40 mg. It has lower toxicity than oral MTX in monotherapy and combination, despite a higher mean dose with highly significant reduction in neutropenia rate and the same rate of liver problems compared to oral. This is the largest study of sc MTX yet reported and supports use of higher doses in selected patients and aggregation or replication of data like this may support license extension for sc MTX beyond 30 mg. If patients are usually switched to sc MTX when oral MTX is ineffective or not tolerated, many do not progress to biologic therapy: delivering good care at lower cost. References: [1]Schiff MH, Jaffe JS, Freundlich B. Ann Rheum Dis2014;73(8):1549–51. [2]Braun J, et al. A&R2008;58(1):73–81. [3] Hazlewood GS, eta l. T. Ann Rheum Dis2016;75(6):1003–08. Disclosure of Interest: None declared