Thursday, 23 Jan 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.

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

Add new comment

More Like This

QD Clinic - "Doc, When Can I Stop?"

QD Clinic - Lessons from the clinic. In this video: Patients stable on a biologic need guidance on when, and if, they can stop their biologic.

QD Clinic - Dealing with Non-adherence

QD Clinic - Lessons from the clinic. Today’s clinic topic: Dealing with Non-Adherence in the Clinic.

NSAID Safety Guidelines

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for acute or chronic arthritis, headache, visceral pain, postoperative pain, etc but come with a small but significant risk of serious adverse effects, including hypertension, cardiovascular disease, kidney injury and GI complications.

Poor Sleep Increases Risk of Cognitive Decline

The Journal of Neurology, Neurosurgery & Psychiatry reports there is moderate evidence that six sleep disorders (insomnia, fragmentation, daytime dysfunction, prolonged latency, rapid eye movement sleep behaviour disorder and excessive time in bed) significantly increases the risk of cognitive disorders.

Metanalysis of 51 previously published reports looked at sleep issues and cognitive health over time.

Rheumatologists Ranked #1 in Happiness (Again)

Medscape has reported the results of its 2020 annual physician survey, This year rheumatologists (60%), general surgeons (60%), public health and preventive medicine physicians, and allergists/immunologists are the "happiest" outside of work compared to other specialists, according to Medscape.

Lowest in happiness were internal medicine, critical care and neurology (44-48%).