engleski

Better quality of life and adherence with less adverse events when switching from oral to subcutaneous methotrexate: results of the six- month observational prospective study in Croatia

Background: It has been demonstrated that bioavailability of oral (P.O.) MTX reaches plateau at doses ≥15 mg QW, and that subcutaneous (S.C.) form has a better efficacy. Alongside with less side-effects this might translate into improvement in quality of life (QoL) and better adherence. Objectives: An academic-induced observational longitudinal study of patients with RA and peripheral form of PsA on csDMARDs who were switched from oral (P.O.) to subcutaneous (S.C.) MTX was conducted. Previously we reported on the better efficacy of S.C. compared to P.O. MTX. The objective of this part of the study we are presenting was to evaluate the 6-month changes in quality of life (QoL), adverse events and adherence in these patients. Methods: Forty-eight consecutive patients (79.2% women) with established diagnosis of RA (77.1%) and peripheral PsA were enrolled from the outpatient clinics in six centres in Croatia. Median age was 61 (39-79) years, and the median of disease duration was 120 (3-528) months. Data were collected at baseline (T0) (on P.O. MTX), at day 90 (±10 days) (T1) and at day 180 (±10 days) (T2), during S.C. MTX treatment. Median dose of MTX remained stable during the study (15mg QW). At each visit QoL was measured using EuroQuol-5D (EQ- 5D), adverse events related to MTX use were recorded, and adherence by the number of missed dose. Results: EQ-5D global health assessment showed significant improvement in quality of life of patients on S.C. MTX during the 6 month follow-up (change from T0 to T2 8.6 ; 95%CI 4.00, 13.3), and the same trend was observed in each of its five component. Number of patients who experienced adverse events related to MTX use has decrease after switching from P.O. to S.C.MTX – from 52.1% during the last 3 months on P.O. MTX to 33.3% during the first 3 months and 18.2% during the last 3 months of S.C. MTX use. During the follow- up adherence to MTX therapy improved, with 25% of patients who missed dose during the last 3 months on P.O. MTX use, to 6, 3% and 2.3% with missed dose in the first and the last 3 months on S.C. MTX, respectively. Conclusion: In our group of patients with RA and peripheral PsA who switched from P.O. to S.C. MTX there was a consistent improvement in QoL, less adverse-events and better adherence.

rheumatoid arthritis ; methotrexate ; switching ; quality of life

nije evidentirano