Methotrexate (MTX), the anchor drug in rheumatoid arthritis (RA) treatment, is currently being underutilized in the U.S., with suboptimal dosing, inadequate duration of therapy, and failure to use subcutaneous (SC) administration.

Researchers analyzed the Symphony Health Solutions database to identify patients diagnosed with RA who were naïve to MTX, in 2009 to 2012. This data included approximately 274 million patients (more than 85% of the US population).  

Of the 35,640 patients who began on PO MTX, 15,599 (44%) remained on this therapy for the five years of the study follow-up. Of the patients who switched therapy during the study period (n=20,041), 17,528 (87%) added or changed to a biologic therapy and the remaining 2,513 (13%) changed to SC MTX. Of the 2,513 patients switched from PO to SC MTX, 1,802 (72%) remained on this therapy for the remainder of the study.

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The authors of the study assert that their findings highlight that MTX is dramatically underused and has a low rate of subcutaneous administration: its most bioavailable way. Only 37% of patients received MTX doses of greater than 15mg/week at the time of adding or changing to biologic therapy, demonstrating that “even when MTX was used the majority of patients are treated with suboptimal MTX doses.”

For SC MTX there was small but statistically significant (P<0.0001) increase in its use after failure of PO MTX, from 13% to 16% of patients, between 2009 to 2012. “While this is a step in the right direction it demonstrates the continued gross underutilization of our anchor DMARD, MTX in its optimal route of administration,” concluded the authors.

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