Exploring Methotrexate Route of Administration Decisions for Adults with Rheumatoid Arthritis

Hannah Moir
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Abstract

Methotrexate is a common first-line treatment for rheumatoid arthritis, yet its widespread and habitual usage often leads physicians to overlook the choice of administration route when planning management strategies. A recent survey involving 30 consultant rheumatologists from France, Germany, Italy, Poland, Spain, and the UK, identified variation in the utilisation and perceptions regarding oral versus subcutaneous delivery for methotrexate. In November 2023, EMJ interviewed Roberto Caporali, Professor of Rheumatology at the University of Milan, and Head of the Department of Rheumatology and Medical Sciences at Gaetano Pini Hospital, Milan, Italy. Caporali’s expertise is in clinical practice, teaching, and research in rheumatology, mainly rheumatoid arthritis and other immune-mediated inflammatory diseases, with a focus on prognostic factors, biomarkers, and treatment for patients with moderate-to-severe active rheumatoid arthritis. During this interview, Caporali discussed the decision-making process for treating rheumatoid arthritis, with a particular focus on the use of methotrexate. The purpose was to gain insights from a rheumatology expert regarding the prevalence and management goals of the disease, and available treatment options. The interview considered key decision-making drivers and barriers to healthcare professionals when selecting the route of administration. Caporali suggested that the efficacy and safety profile of methotrexate when delivered subcutaneously may be the optimal choice for patients, often resulting in higher adherence compared to oral dosing. Caporali recommended education and re-evaluation of local guidelines to improve patient outcomes by better understanding the optimal use and efficacy of methotrexate.
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探索类风湿关节炎成人患者的甲氨蝶呤给药途径决策
甲氨蝶呤是治疗类风湿性关节炎的常用一线疗法,但其广泛而习惯性的使用常常导致医生在规划治疗策略时忽略给药途径的选择。最近,一项由来自法国、德国、意大利、波兰、西班牙和英国的 30 位风湿病顾问医生参与的调查发现,甲氨蝶呤口服给药与皮下注射给药在使用和认知上存在差异。2023 年 11 月,《欧洲医学杂志》采访了米兰大学风湿病学教授、意大利米兰加埃塔诺-皮尼医院风湿病学和医学科学部主任罗伯托-卡波拉利(Roberto Caporali)。卡波拉利的专长是风湿病学的临床实践、教学和研究,主要是类风湿性关节炎和其他免疫介导的炎症性疾病,重点是中重度活动性类风湿性关节炎患者的预后因素、生物标志物和治疗。 在这次访谈中,卡波拉利讨论了治疗类风湿性关节炎的决策过程,尤其关注甲氨蝶呤的使用。访谈的目的是从风湿病学专家那里了解该疾病的发病率、管理目标以及现有的治疗方案。 访谈考虑了医护人员在选择给药途径时的关键决策驱动因素和障碍。Caporali 认为,甲氨蝶呤皮下给药的疗效和安全性可能是患者的最佳选择,与口服给药相比,患者的依从性往往更高。Caporali 建议开展教育并重新评估当地指南,通过更好地了解甲氨蝶呤的最佳使用方法和疗效来改善患者的治疗效果。
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