Methotrexate Frequently Prescribed Incorrectly

Methotrexate is frequently prescribed incorrectly in the United States. It’s under-dosed, prescribed for inadequate time periods and is rarely switched to the subcutaneous version before biologics are initiated.

Methotrexate is frequently prescribed incorrectly in the United States, a recent study found. It’s under-dosed, prescribed for inadequate time periods, and is rarely switched to the subcutaneous version before biologic are initiated.

If methotrexate was better appropriated, rheumatoid arthritis could be better controlled and it could produce significant cost savings.

In a presentation given on Nov. 9 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., James O’Dell, M.D., University of Nebraska Medical Center rheumatology division chief, discussed how methotrexate is prescribed to treat rheumatoid arthritis and whether it can be used more effectively.

The study pulled health information from Symphony Health Solutions, including demographic characteristics, switches from oral to subcutaneous methotrexate or a biologic with or without concomitant methotrexate, timing of any changes, dosing at the time of changes. Researchers concentrated on patients who received an ICD-9 diagnosis of 714.0 or 714.30 and initiated methotrexate treatment in 2009, following their outcomes through 2014.

Out of 35,640 individuals, 15,599 (43.8 percent) received continuous oral methotrexate, and 17,528 (49.2 percent) added or switched to a biologic agent. Seven percent switched from oral to subcutaneous methotrexate.

Analysis showed that switching to subcutaneous methotrexate prevents the need for or extends the time to the addition of a biologic. More than 40 percent of rheumatoid arthritis patients who started oral methotrexate switched to or added a biologic within 90 days after a median dose of 15 mg/week.

Of those who switched to subcutaneous methotrexate, 71 percent remained on the same treatment for three years, adding a biologic after 289 days. The average time of progression to a biologic was longer for patients who switched to subcutaneous methotrexate (823 days) than those who switched to oral methotrexate (170 days).