Are We Using Methotrexate Appropriately? Save

Methotrexate is a mainstay drug in the treatment of rheumatoid arthritis (RA).  Yet, we may not be using it long enough or optimizing its use.  

Dr. Jim O'Dell presented his findings this week during a plenary session at the ACR meeting in San Francisco. Using a claims database of over 274 million US patients, the treatment of 35,640 RA patients was examined between 2009 and 2014.

Of the 35,640 patients, 44% remained on oral MTX monotherapy (mean dose 15.3 mg/wk) during this period, while 49% added or switched to a biologic treatment. Biologics were added after a median of 170 days. More than 40% of RA patients starting treatment with oral MTX switched to or added a biologic within 90 days, but only after a median dose of only 15 mg/week.

Only a small percentage (7%) of RA patients switched to from oral to subcutaneous MTX.

Dr. O'Dell contends that MTX is frequently under-dosed, given for an inadequate length of time, and rarely switched to SC before the initiation of biologic therapy.  More appropriate optimization of MTX could lead to better control of RA and would be expected to produce significant cost savings.