Drug-related problems experienced by rheumatoid arthritis patients during the first three months of methotrexate use: a longitudinal observational study.

Abstract

Background: Methotrexate (MTX) is the cornerstone of rheumatoid arthritis (RA) treatment. However, patients using MTX often experience drug-related problems (DRPs), negatively affecting adherence and persistence.

Aim: To identify the number and type of DRPs experienced by RA patients during the first 3 months of MTX treatment.

Method: A longitudinal observational study was conducted in the Sint Maartenskliniek, The Netherlands, between March and August 2023. Adult RA patients were interviewed at 2, 6 and 12 weeks after MTX initiation using the United Kingdom's New Medicines Service interview guide. DRPs were categorized using a classification system for patient-reported DRPs, and analyzed descriptively.

Results: All fifty participants (median age 62 years (IQR 51-68), 66% female) reported a DRP, with a median of 6 (IQR 3-8) DRPs per patient and a total of 301 DRPs. The top 5 most frequently reported DRPs were concerns about (long-term) side-effects, nausea, fatigue, remembering intake and information needs regarding dose instructions. Of the DRPs reported at weeks 2 and 6, 33% were unresolved at week 12.

Conclusion: Patients with RA experience numerous DRPs in the first 3 months of MTX use. Resolving DRPs soon after occurrence may reduce the burden of drug treatment and improve adherence and/or persistence.