Parenteral methotrexate more effective than oral for rheumatoid arthritis treatment, reveals study

USA: Parenteral administration of methotrexate (MTX) is more effective than the oral form for the treatment of rheumatoid arthritis (RA), finds a recent study published in the journal PLOS One.

The results suggest that widespread use of methotrexate may lead to better disease control and a decrease in demand for biologic agents.

Rheumatoid arthritis is a chronic inflammatory disease that affects a person's joints, causing pain and disability. It can also affect internal organs. RA is more common in older people, but there is also a high prevalence in young adults, adolescents, and even children, and it affects women more frequently than men.

Ear;y detection of the disease followed by timely optimal management lessens joint damage, disability and overall mortality, and more frequent disease remissions.

ACR and EULAR are recommended methotrexate monotherapy as the first strategy for early rheumatoid arthritis in their updated recommendations.

Given the important impact that route of administration may have on the bioavailability and efficacy of methotrexate, its beneficial cost and side effect profile compared with biologics, along with the lack of rigorous data, Andreea M. Bujor, Boston University School of Medicine, Boston, Massachusetts, US, and colleagues aimed to carried out a meta-analysis to compare the efficacy and safety of oral versus parenteral methotrexate in rheumatoid arthritis .

For the purpose, the researches systematically searched online databases from inception to June 8, 2017, and reviewed following PRISMA 2009 guidelines. To be selected, the trials had to study adults with rheumatoid arthritis randomized to the same dose of either oral or parenteral MTX. The primary endpoint was ACR20 at 6 months. Relative treatment effects were generated as an odds ratio [OR] (OR>1 indicated a benefit for parenteral therapy).

• The search yielded 357 papers or abstracts.


• After review of titles or abstracts and full-text papers, the researches found 4 that met inclusion criteria with 703 patients randomized.


• A dose of MTX started at 15mg/week and increased up to 25mg/week.


• Parental MTX was associated with 3-fold odds of achieving ACR20 at 6 months.


• Parental MTX did not carry greater risk for adverse events or adverse events leading to discontinuation.

"Our results demonstrate that the 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," concluded the authors.

To read the complete study log on to https://doi.org/10.1371/journal.pone.0221823