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Patient ’ s experience with subcutaneous and oral methotrexate for the treatment of rheumatoid arthritis

View Article: PubMed Central - PubMed

ABSTRACT

Background: Despite the prominent position of methotrexate (MTX) in Rheumatoid Arthiris (RA) therapeutics, its real-world effectiveness may be influenced by a relative lack of tolerability or other side effects that physicians may not be aware of but that are bothersome to patients.

Background: The aim of this study is to identify suboptimal patient experience with MTX and to raise awareness for clinicians to identify opportunities to mitigate bothersome symptoms and side effects and optimize response to MTX.

Methods: We conducted a prospective, cross-sectional, online survey among RA patients who were members of Creakyjoints, a large arthritis patient community. Eligible participants must have recently initiated a new biologic, subcutaneous (SQ) MTX, or oral MTX in the last 12 months and were uniquely assigned to one of these 3 groups. Descriptive statistics were used to compare patient-reported side effects and tolerability related to MTX use in the 3 medication groups (SQ MTX, oral MTX, and biologic).

Results: A total of 382 (85 %) of 448 eligible patients completed the survey and were grouped as: biologic (n = 218), SQ MTX (n = 49), and oral MTX (n = 115). Demographics were mean standard deviation (SD) age 48 (10) years, 92 % white, 91 % women. Symptoms significantly more prevalent in the SQ and oral MTX groups included diarrhea, fatigue, malaise, and hair loss. Injection related pain was lower with SQ MTX compared to SQ biologics. Out of a total of 8 potential symptoms and side effects examined, higher dose MTX (> = 20 mg/week) was associated with a 2.26 (1.25–4.09) greater likelihood of more side effects referent to < =10 mg/week.

Conclusion: Results from this real-world RA patient cohort suggest that MTX is accompanied by many patient-reported side effects and tolerability problems that may be under-recognized by physicians. These may impact both treatment satisfaction and medication adherence.

No MeSH data available.


Mean pain scores associated with subcutaneous MTX vs etanercept and adalimumab. *patients who said that they experienced no pain with injection are included as having a 0 pain score. MTX, methotrexate
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Fig3: Mean pain scores associated with subcutaneous MTX vs etanercept and adalimumab. *patients who said that they experienced no pain with injection are included as having a 0 pain score. MTX, methotrexate

Mentions: The severity of each of these patient-reported symptoms is described in Table 4. Differences between the 3 treatment groups largely mirrored the differences in incidence described in Table 3. Conditional on patients having each of these side effects, the severity of the specific side effect did not differ between treatments except for mental fog for which severity was greater in both MTX treatment groups compared to biologics. Among the subgroup of patients currently receiving oral or SQ MTX (with or without biologics), there was an association between the dose of MTX and the number of side effects experienced (Fig. 2). Patients receiving MTX at weekly doses of < = 10 mg had fewer side effects than those receiving higher doses. Results from the ordinal logistic regression showed that referent to < =10 mg/week, patients receiving between 10 and 20 mg/week had a 1.57 (0.86–2.87) higher odds of a higher number of side effects, and patients receiving > =20 mg/week had a 2.26 (1.25–4.09) higher odds of more side effects. Patient-reported pain associated with SQ injections (Fig. 3) was significantly greater for the administration of etanercept and adalimumab compared with SQ MTX (P < 0.0001 for each), but etanercept and adalimumab were not different from other another.Table 4


Patient ’ s experience with subcutaneous and oral methotrexate for the treatment of rheumatoid arthritis
Mean pain scores associated with subcutaneous MTX vs etanercept and adalimumab. *patients who said that they experienced no pain with injection are included as having a 0 pain score. MTX, methotrexate
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5037591&req=5

Fig3: Mean pain scores associated with subcutaneous MTX vs etanercept and adalimumab. *patients who said that they experienced no pain with injection are included as having a 0 pain score. MTX, methotrexate
Mentions: The severity of each of these patient-reported symptoms is described in Table 4. Differences between the 3 treatment groups largely mirrored the differences in incidence described in Table 3. Conditional on patients having each of these side effects, the severity of the specific side effect did not differ between treatments except for mental fog for which severity was greater in both MTX treatment groups compared to biologics. Among the subgroup of patients currently receiving oral or SQ MTX (with or without biologics), there was an association between the dose of MTX and the number of side effects experienced (Fig. 2). Patients receiving MTX at weekly doses of < = 10 mg had fewer side effects than those receiving higher doses. Results from the ordinal logistic regression showed that referent to < =10 mg/week, patients receiving between 10 and 20 mg/week had a 1.57 (0.86–2.87) higher odds of a higher number of side effects, and patients receiving > =20 mg/week had a 2.26 (1.25–4.09) higher odds of more side effects. Patient-reported pain associated with SQ injections (Fig. 3) was significantly greater for the administration of etanercept and adalimumab compared with SQ MTX (P < 0.0001 for each), but etanercept and adalimumab were not different from other another.Table 4

View Article: PubMed Central - PubMed

ABSTRACT

Background: Despite the prominent position of methotrexate (MTX) in Rheumatoid Arthiris (RA) therapeutics, its real-world effectiveness may be influenced by a relative lack of tolerability or other side effects that physicians may not be aware of but that are bothersome to patients.

Background: The aim of this study is to identify suboptimal patient experience with MTX and to raise awareness for clinicians to identify opportunities to mitigate bothersome symptoms and side effects and optimize response to MTX.

Methods: We conducted a prospective, cross-sectional, online survey among RA patients who were members of Creakyjoints, a large arthritis patient community. Eligible participants must have recently initiated a new biologic, subcutaneous (SQ) MTX, or oral MTX in the last 12&nbsp;months and were uniquely assigned to one of these 3 groups. Descriptive statistics were used to compare patient-reported side effects and tolerability related to MTX use in the 3 medication groups (SQ MTX, oral MTX, and biologic).

Results: A total of 382 (85&nbsp;%) of 448 eligible patients completed the survey and were grouped as: biologic (n&thinsp;=&thinsp;218), SQ MTX (n&thinsp;=&thinsp;49), and oral MTX (n&thinsp;=&thinsp;115). Demographics were mean standard deviation (SD) age 48 (10) years, 92&nbsp;% white, 91&nbsp;% women. Symptoms significantly more prevalent in the SQ and oral MTX groups included diarrhea, fatigue, malaise, and hair loss. Injection related pain was lower with SQ MTX compared to SQ biologics. Out of a total of 8 potential symptoms and side effects examined, higher dose MTX (&gt;&thinsp;=&thinsp;20&nbsp;mg/week) was associated with a 2.26 (1.25&ndash;4.09) greater likelihood of more side effects referent to&thinsp;&lt;&thinsp;=10&nbsp;mg/week.

Conclusion: Results from this real-world RA patient cohort suggest that MTX is accompanied by many patient-reported side effects and tolerability problems that may be under-recognized by physicians. These may impact both treatment satisfaction and medication adherence.

No MeSH data available.