Rheumatoid arthritis: parenteral MTX tops pills for efficacy

  • Bujor AM & al.
  • PLoS ONE
  • 1 Jan 2019

  • International Clinical Digest
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Takeaway

  • Odds of achieving a 20% improvement in disease activity per American College of Rheumatology criteria (ACR20) are 3-fold higher with parenteral vs oral methotrexate (MTX) in rheumatoid arthritis. 

Why this matters

  • Parenteral MTX has greater bioavailability than oral MTX.
  • Widespread adoption of parenteral MTX may yield better disease control and a consequent decrease in demand for biological agents.

Study design

  • Meta-analysis of 4 randomized controlled trials (N=703 patients) identified from a search of PubMed, Web of Science, and EMBASE.
  • MTX dose started at 15 mg/week and increased no higher than 25 mg/week.
  • Primary outcome: ACR20 at 6 months.
  • Funding: None.

Key results

  • Parental MTX was associated with 3-fold odds of achieving ACR20 at 6 months (OR, 3.02; 95% CI, 1.41-6.46).
  • Parental MTX did not carry greater risk for adverse events (P=.82) or adverse events leading to discontinuation (P=.1).

Limitations

  • High heterogeneity across studies (I2=70.07%).