RESEARCH - Better efficacy of MTX given by IM injection than orally in patients with RA

September 20, 2004

Ann Rheum Dis. 2004 Oct;63(10):1232-4.

Better efficacy of methotrexate given by intramuscular injection than

orally in patients with rheumatoid arthritis.

Wegrzyn J, Adeleine P, Miossec P.

Clinical Immunology Unit, Departments of Immunology and Rheumatology,

Hopital Edouard Herriot, Lyon, 69 437 Lyon Cedex 03, France.

miossec@...

OBJECTIVE: To compare the clinical efficacy of methotrexate and

tolerance to the drug in patients with rheumatoid arthritis who were

switched from intramuscular to oral administration because of a shortage

of the intramuscular preparation. METHODS: 143 patients were switched

from intramuscular to oral methotrexate. Of these, 47 were switched back

to the intramuscular form. A multiple choice questionnaire was sent by

mail to evaluate clinical and biological criteria of efficacy and

tolerance. RESULTS: When methotrexate was first switched from

intramuscular to oral administration, increased disease activity,

exacerbation of morning pain and hand stiffness, duration of morning

stiffness, increased joint pain, and increased joint swelling were

observed. There was a greater frequency of gastrointestinal symptoms,

but without a significant increase in liver abnormalities. When

intramuscular methotrexate became available again, 47 of the 143

patients were switched back and were followed for at least three months.

On average, disease manifestations were improved and side effects

reduced by the switch.

CONCLUSIONS: Methotrexate given intramuscularly had improved clinical

efficacy with fewer side effects than given orally. Intramuscular

methotrexate administration should be considered when rheumatoid

arthritis remains active in spite of high dose oral methotrexate.

PMID: 15361377

5361377 & dopt=Abstract

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Mayo Clinic in Rochester

s Hopkins Medicine

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