Utilization of Subcutaneous Methotrexate in Rheumatoid Arthritis Patients After Failure or Intolerance to Oral Methotrexate: A Multicenter Cohort StudyReportar como inadecuado




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Advances in Therapy

, Volume 33, Issue 1, pp 46–57

First Online: 02 January 2016Received: 12 October 2015DOI: 10.1007-s12325-015-0276-3

Cite this article as: Branco, J.C., Barcelos, A., de Araújo, F.P. et al. Adv Ther 2016 33: 46. doi:10.1007-s12325-015-0276-3

Abstract

IntroductionLow-dose weekly methotrexate MTX is the mainstay in the therapy of rheumatoid arthritis RA. It can be given via oral, intramuscular or subcutaneous SC route. This study sought to determine the real-world pattern of treatment with SC MTX in Portuguese adult patients with active RA.

MethodsUtilization of Metoject in Rheumatoid Arthritis UMAR was a non-interventional, cohort multicenter study with retrospective data collection. Eligible patients had active RA, at least 18 years of age, and started SC MTX treatment in 2009 or 2010 after failure or intolerance to oral MTX. Data were collected from patient’s clinical records. Both non-parametric and parametric survival methods were used to obtain a detailed understanding of SC MTX treatment duration.

ResultFifty patients were included, of which only 9 discontinued SC MTX during the study follow-up period. The probability of discontinuation after 1, 2, and 3 years of treatment of SC MTX treatment is expected to be 6.10%, 8.50%, and 23.20%, respectively. The extrapolated median duration of SC MTX using an exponential model was 106.4 months-8.87 years. Mean dose of SC MTX was 18.36 mg. The reasons for treatment discontinuation were occurrence of adverse events in six patients and lack of efficacy in three.

ConclusionThe long treatment duration of SC MTX highlights its excellent tolerability compared to oral MTX, especially concerning the frequent adverse gastrointestinal events of MTX. Furthermore, long MTX treatment duration provides the opportunity to postpone or even avoid expensive therapies with biologics. The results obtained from the UMAR study provide important information for the utilization and public financing of SC MTX in Portugal.

KeywordsContinuation rates Methotrexate Methotrexate failure Oral treatment Rheumatoid arthritis Subcutaneous methotrexate Subcutaneous treatment Treatment duration UMAR Electronic supplementary materialThe online version of this article doi:10.1007-s12325-015-0276-3 contains supplementary material, which is available to authorized users.

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Autor: Jaime C. Branco - Anabela Barcelos - Filipe Pombo de Araújo - Graça Sequeira - Inês Cunha - José Vaz Patto - Margari

Fuente: https://link.springer.com/







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