Subcutaneous vs. Oral Methotrexate for Patients with Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) may glean benefits from treatment with subcutaneous methotrexate, according to findings published in the Annals of the Rheumatic Diseases.

Researchers from Hospital for Special Surgery in New York City included 666 patients in multicenter prospective cohort study designed to determine the comparative effectiveness of oral versus subcutaneous methotrexate as initial therapy for early RA patients. The researchers wanted to determine the benefits of the subcutaneous version of methotrexate compared to the oral type over the first year, specifically. There were 417 oral methotrexate patients and 249 subcutaneous methotrexate patients included in the study. Additionally, data was collected from the patients regarding their Disease Activity Score and the Health Assessment Questionnaire Disability Index.

The patients prescribed the subcutaneous methotrexate were prescribed a higher dose of the drug compared to the oral methotrexate patients. The researchers determined the mean dose over the first 3 months was 22.3 mg vs. 17.2 mg per week between the subcutaneous and oral methotrexate groups, respectively.

At 12 months, about half of the patients (49 percent) initially treated with the subcutaneous methotrexate therapy had changed treatment, whereas more than three fourths (77 percent) of the patients treated first with oral methotrexate underwent a change.

Subcutaneous methotrexate was linked to a lower average Disease Activity Score — the mean difference was about -0.38 between the subcutaneous methotrexate and oral methotrexate groups. The researchers noted a small difference in Disease Activity Score remission, too. The researchers did not identify any significant differences among the oral and subcutaneous methotrexate groups in terms of sustained remission or Health Assessment Questionnaire Disability Index.

“Initial treatment with subcutaneous methotrexate was associated with lower rates of treatment changes, no difference in toxicity and some improvements in disease control versus oral methotrexate over the first year in patients with early RA patients,” the authors concluded in the journal.

The researchers also determined that subcutaneous methotrexate was linked to a lower rate of treatment failure, after they had made adjustments for potential confounders. Most of the treatment failures experienced by the patients were attributed to inefficacy, but there was no difference in failure due to toxicity, the researchers noted.