engleski

Efficacy and safety of switching from oral to subcutaneous methotrexate in everyday clinical practice: results of the six-month observational prospective study in Croatia

Background: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic debilitating infl ammatory rheumatic conditions with the major impact on quality of life (QoL). csDMARDs are the basic pharmacological option for these patients, and choice of DMARDs depends on many factors. Objectives: Th e objective of this study was to evaluate the changes in disease activity, QoL, adverse events when switching from oral to subcutaneous methotrexate (MTX) in patients with RA and PsA, addressing also the adherence to treatment. Methods: Th is was an observational prospective longitudinal study of patients with RA and PsA on csDMARDs who switched from oral to s.c. MTX. Consecutive patients with established diagnosis of RA and PsA were enrolled from the outpatient clinics of 6 centres in Croatia. Th ere were 48 patients (79.2% women), of median age 61 (range 39–79), and with the median of disease duration of 120 months. Data were collected at baseline (T0) including retrospective data collection for the previous 3 months (on oral MTX), at day 90 (±10 days) (T1) and at day 180 ((±10 days) (T2) for the previous periods (both of them during s.c. MTX treatment). Dose of MTX remained stable during the study. Domains of interest were: DAS28, level of pain, PtGHA and PhGHA, QoL (EQ5Q) and physical function (HAQ-DI). Adherence to treatment and safety data were recorded, too. Results: In a comparison between T0 and T1/T2 there was more chance for patients having low to moderate disease activity aft er 3 and 6 moths of s.c. MTX (8.0 ; 95%CI 1.9- 32.0) and less chance to have high disease activity (0.25 ; 95%CI 0.11-0.48) in comparison to the baseline DAS 28 (on oral MTX). Adjusted mean values for intensity of pain, PtGHA and PhGHA showed signifi cant decrease for T1 and T2 versus T0 assessment (– 1.46 ; 95%CI –1.55 to –0.35 ; – 1.12 ; 95%CI –1.50 to – 0.73 ; –1.15 ; 95%CI –1.50 to –0.80, respectively). Also, in the same comparison EQ-5D global health showed signifi cant improvement (8.6 ; 95%CI 4.00 to 13.3), as well as HAQ-DI (–0.25 ; 95%CI –0.32 to –0.17). In the retrospective analysis there were more missed doses of oral compared to s.c. MTX, while on the other hand adverse events were less frequent with s.c. compared to oral MTX. Conclusions: In the group of patients with RA and PsA who switched from oral to s.c. MTX improvement was observed in multiple outcomes including disease activity, QoL and safety as well as better adherence.

rheumatoid arthritis ; methotrexate ; oral ; subcutaneous

nije evidentirano