Methotrexate oral to injection conversion

To the Editor: Many inflammatory skin disorders can be treated with weekly low-dose oral methotrexate (oMTX). However, nausea (25%) and asthenia (15%) are common adverse effects (AEs) that reduce drug survival. Learn about the different methotrexate delivery methods. Compare oral methotrexate with injectable methotrexate (an auto-injector). Oral vs. subcutaneous (sq) administration of methotrexate is generally considered equivalent in rheumatoid arthritis (RA) treatment. However, the enhanced bioavailability of sq methotrexate may make this route of administration preferable to the oral route in certain patients. What we find is the majority of patients who are on subcutaneous methotrexate started on oral methotrexate. Now, in the studies, we can find that there is an advantage to starting patients on injectable methotrexate. SC MTX is purported to have higher efficacy and same or better tolerability compared to the oral route. Switching from oral to SC MTX may delay the need for biologics, which has substantial cost-savings. Oral to Subcutaneous Methotrexate Dose-Conversion Strategies in the Treatment of Rheumatoid Arthritis Michael Schiff1 and Peter Sadowski 2, 1 Division of Rheumatology, University of Colorado, Denver, CO, 2 Antares Pharma Inc., Minneapolis, MN If changing from oral to subcutaneous administration a reduction of the dose may be required due to the variable bioavailability of methotrexate after oral administration. When converting from intravenous (IV) to oral (PO) methotrexate, the same dose should be used initially, but an increase of 2.5-5 mg in the oral dose may be necessary due to lower oral bioavailability, particularly at doses above 15 mg/week. In this paper, we establish a dose-conversion method based on the BA of MTX from oral and SC administration. SC administration provided higher exposure of MTX than the same dose given orally. Objectives: The aim of our study is to review whether switching of oral methotrexate (PO MTX) to subcutaneous methotrexate (SC MTX) helps to improve disease activity in patients with rheumatoid arthritis and avoids the need to introduce biologic therapy.

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