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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.