Session Title: Clinical Practice/Patient Care
Session Type: Abstract Submissions (ARHP)
Methotrexate (MTX) is the anchor medication for the management of rheumatoid arthritis (RA); however there is limited patient-focused data available on the use of MTX, which could be used to improve RA outcomes. The primary objective of this study, termed MATRIX (Mapping Australian Treatment Reality Involving MTX), was to assess the use and perceptions of MTX by patients with RA. Secondary objectives included the assessment of patient-reported adverse events, the use of alcohol, folic acid, and biologic agents, and the perceptions of rheumatologists. Here we highlight tolerability to MTX, the perceptions of rheumatologists, and the use of biologic agents.
Rheumatologists (N = 46 of 50 completed surveys) and their patients with RA (N = 1,313 of 1,500 completed surveys; consecutively sampled); mean age 58.5 years, 72% female) completed pre-tested, voluntary, anonymous, self-administered questionnaires about their experience with MTX.
Generally, patients reported taking oral MTX regularly (78% currently taking MTX, 92% orally, 70% ≥ 10 mg / week) and followed prescription instructions (91% took folic acid; 46% abstained from alcohol). However, 17% of patients had discontinued from MTX (13% within 1 to 2 years), mostly because of adverse events (12%). For patients taking MTX, adverse events (including nausea, headache, mouth ulcers, light-headedness, and diarrhea) were noted by 60% of patients, but events were experienced regularly (92%) and some were continual (13%). Most patients (72%) reported never missing a dose of MTX, but 6% miss at least 1 dose every 2 months and 8% intentionally and regularly ‘take a break’ from MTX, despite regular attendance at the clinic. Although rheumatologists were aware of tolerability to MTX, they generally underestimated the positive attitude that patients had towards their MTX therapy; for example 35% of patients would prefer to discontinue MTX but rheumatologists estimated 47% of patients would prefer to discontinue MTX. Rheumatologists also underestimated the proportion of patients who reported taking biologic agent ‘monotherapy’ (ie, without MTX; ≤ 20%); 29% of patients were on biologic agents, and of these, 29% were taking biologic agent ‘monotherapy’ and 70% were taking biologic agents in combination with MTX. The most common biologic agents were adalimumab, etanercept, and tocilizumab; tocilizumab use was higher with biologic agent ‘monotherapy’. Of note, compared with all patients a greater proportion of patients taking biologic agents would prefer to discontinue MTX (43%).
MTX was well-used and positively perceived by patients with RA. However, our study highlights the need for rheumatologists to monitor patient use of RA medication with the aim of ensuring patients continue with, and maximize, their use of MTX therapy, particularly in combination with biologic agents.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-survey-study-of-methotrexate-use-by-rheumatologists-and-their-patients-with-rheumatoid-arthritis/