title: Utilization of Subcutaneous Methotrexate in Rheumatoid Arthritis Patients After Failure or Intolerance to Oral Methotrexate: A Multicenter Cohort Study.
abstract: BACKGROUND
  Low-dose weekly methotrexate (MTX) is the mainstay in the therapy of rheumatoid arthritis (RA). It can be given via oral, intramuscular or subcutaneous (SC) route. This study sought to determine the real-world pattern of treatment with SC MTX in Portuguese adult patients with active RA.
  
  
  METHODS
  Utilization of Metoject(®) in Rheumatoid Arthritis (UMAR) was a non-interventional, cohort multicenter study with retrospective data collection. Eligible patients had active RA, at least 18 years of age, and started SC MTX treatment in 2009 or 2010 after failure or intolerance to oral MTX. Data were collected from patient's clinical records. Both non-parametric and parametric survival methods were used to obtain a detailed understanding of SC MTX treatment duration.
  
  
  RESULTS
  Fifty patients were included, of which only 9 discontinued SC MTX during the study follow-up period. The probability of discontinuation after 1, 2, and 3 years of treatment of SC MTX treatment is expected to be 6.10%, 8.50%, and 23.20%, respectively. The extrapolated median duration of SC MTX using an exponential model was 106.4 months/8.87 years. Mean dose of SC MTX was 18.36 mg. The reasons for treatment discontinuation were occurrence of adverse events in six patients and lack of efficacy in three.
  
  
  CONCLUSIONS
  The long treatment duration of SC MTX highlights its excellent tolerability compared to oral MTX, especially concerning the frequent adverse gastrointestinal events of MTX. Furthermore, long MTX treatment duration provides the opportunity to postpone or even avoid expensive therapies with biologics. The results obtained from the UMAR study provide important information for the utilization and public financing of SC MTX in Portugal.
authors.affiliation: CEDOC-Nova Medical School, Faculdade de Ciências Médicas da Universidade de Lisboa, Lisbon, Portugal. jaime.branco@nms.unl.pt.
authors.forename: Jaime C
authors.initials: JC
authors.lastname: Branco
authors.affiliation: Centro Hospitalar do Baixo Vouga, E.P.E., Hospital Infante D. Pedro, Aveiro, Portugal.
authors.forename: Anabela
authors.initials: A
authors.lastname: Barcelos
authors.affiliation: Centro Hospitalar de Lisboa Ocidental, E.P.E., Hospital de Egas Moniz, Lisbon, Portugal.
authors.forename: Filipe Pombo
authors.initials: FP
authors.lastname: de Araújo
authors.affiliation: Hospital de Faro, E.P.E., Faro, Portugal.
authors.forename: Graça
authors.initials: G
authors.lastname: Sequeira
authors.affiliation: Centro Hospitalar do Baixo Vouga, E.P.E., Hospital Infante D. Pedro, Aveiro, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Cunha
authors.affiliation: Instituto Português de Reumatologia, Lisbon, Portugal.
authors.forename: José Vaz
authors.initials: JV
authors.lastname: Patto
authors.affiliation: Centro Hospitalar Cova da Beira, E.P.E., Covilhã, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Oliveira
authors.affiliation: Centro Hospitalar de Lisboa Ocidental, E.P.E., Hospital de Egas Moniz, Lisbon, Portugal.
authors.forename: Margarida Pratas
authors.initials: MP
authors.lastname: Mateus
authors.affiliation: Centro Hospitalar Tondela-Viseu, E.P.E., Hospital de São Teotónio, Viseu, Portugal.
authors.forename: Maura
authors.initials: M
authors.lastname: Couto
authors.affiliation: Centro Hospitalar de Lisboa Ocidental, E.P.E., Hospital de Egas Moniz, Lisbon, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Nero
authors.affiliation: Centro Hospitalar Vila Nova de Gaia, Espinho, E.P.E., Vila Nova de Gaia, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Pinto
authors.affiliation: Centro Hospitalar Tondela-Viseu, E.P.E., Hospital de São Teotónio, Viseu, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Monteiro
authors.affiliation: Centro Hospitalar de Lisboa Ocidental, E.P.E., Hospital de Egas Moniz, Lisbon, Portugal.
authors.forename: Walter
authors.initials: W
authors.lastname: Castelão
authors.affiliation: Exigo Consultores, Lisbon, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Félix
authors.affiliation: Exigo Consultores, Lisbon, Portugal.
authors.forename: Diana
authors.initials: D
authors.lastname: Ferreira
authors.affiliation: Exigo Consultores, Lisbon, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Almeida
authors.affiliation: Exigo Consultores, Lisbon, Portugal.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Silva
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D008727:Methotrexate
keywords: Continuation rates; Methotrexate; Methotrexate failure; Oral treatment; Rheumatoid arthritis; Subcutaneous methotrexate; Subcutaneous treatment; Treatment duration; UMAR