Friday, 27 Mar 2020

You are here

Parenteral Out-Performs Oral Weekly Methotrexate

A systematic review in PLOS suggests that parenteral MTX therapy is more successful than oral MTX in achieving optimal disease activity control. 

A meta-analysis to compare the efficacy of oral versus parenteral MTX in RA used the ACR20 response at 6 mos as the primary endpoint.  Out of a search result of 357 papers, they found only 4 studies that met inclusion criteria; this included a total of 703 patients randomized to either treatment. MTX dosing started at 15mg/week and was increased up to 25mg/week.

The odds of achieving ACR20 was higher using parenteral (vs. oral) with an OR = 3.02 (95% CI 1.41, 6.46). Those on parenteral MTX had a 20% greater odds of attaining ACR20 improvement (95% CI 5.0%, 35.3%) compared to those on oral MTX.

Overall there were no significant differences in adverse events between groups.

The authors propose more widespread use of parenteral MTX to better control of disease and decrease the demand for biologic agents.

The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

COVID Infection Run Down with Dr. Kevin Winthrop

Dr Kevin Winthrop answers COVID questions and advocates for "hit the pause button, lay low and exercise". We discuss the utility of baricitinib, losartan, COVID testing, Next Success and who to listen to.

Dr. Artie Kavanaugh - Don't Stop!

Drs. Cush and Kavanaugh discuss the downside of stopping hydroxychloroquine, DMARDs and biologics in lupus, RA and pregnancy.

Venom Peptide-Steroid Conjugate Effective in Collagen Induced Arthritis

Science Translational Medicine features a report from the Fred Hutchinson Cancer Research Center showing that a scopion venom peptide, coupled to steroid, can significantly reduce joint inflammation in a rat model of rheumatoid arthritis (RA).

ACR Releases Reproductive Health Guidelines for Rheumatic Diseases

Today, the American College of Rheumatology (ACR) published the 2020 Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. This is the first, evidence-based, clinical practice guideline related to the management of reproductive health issues for all patients with rheumatic diseases.

Adverse Effects of Low-Dose Methotrexate from the CIRT Trial

Low-dose methotrexate (LD-MTX) was studied in high risk cardiac patients in the cardiac intervention trial (CIRT), but was prematurely ended for not showing a change in cardiovascular event rates. Nonetheless this trial studied the safety and adverse event rates of LD-MTX and those results are reported in the current issue of Annals of Internal Medicine.