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Study: Methotrexate Underused as Treatment for Patients With RA
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Compared with guidelines for usage, methotrexate use for patients with rheumatoid arthritis had low dosing; short-therapy duration; and was underused for subcutaneous administration, according to a cohort analysis from 2009 to 2014.
“Rheumatologists in the [United States] U.S. are dramatically underutilizing [methotrexate] MTX,” James R. O’Dell, MD, in the Division of Rheumatology at the University of Nebraska College of Medicine, told Healio Rheumatology. “They are not using it long enough, at [a] high enough dose and are rarely using [it] in [subcutaneous administration].”
O’Dell and colleagues used data from Symphony Health Solutions — which covers 274 million patients in the United States — to find patients diagnosed with rheumatoid arthritis (RA) in 2009 or 2012 and were naïve to MTX treatment. The researchers recorded comorbidities, medication use and medication dosage with 5-year follow-up.
In 2009, the researchers found 36,640 patients received oral MTX. Of these patients, 44% of whom remained on treatment through 2014. Of this group, 25% received a biologic before MTX. Of those who received MTX first, 37% received doses greater than 15 mg per week at the time or were adding or were switching to a biologic. In addition, 41% of patients stopped oral MTX therapy after 3 months, despite evidence that MTX does not reach 90% of the maximum steady-state concentration until 6 months.
Of the 20,041 patients who changed therapy, 87% added or switched to a biologic and 13% switched from oral to subcutaneous MTX. The mean oral dose was 15.3 mg per week in 2009 and 15.9 mg in 2012. Furthermore, 13% of patients used subcutaneous MTX in 2009, which increased to 16% in 2012.
These results suggest that most patients received suboptimal dosage, duration and subcutaneous administration of MTX, the researchers wrote.
“Better use of MTX, the anchor drug for RA treatment, would result in better and more economical outcomes for our patients,” O’Dell said. – by Will Offit
Disclosures: O’Dell reports personal fees from Medac as a consultant and member of the advisory board. Please see the full study for a list of all other authors’ relevant financial disclosures.
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