Patients who do not respond well to oral methotrexate (or who experience adverse gastrointestinal side effects) may benefit from subcutaneous methotrexate.
Methotrexate is more bioavailable when administered subcutaneously than when administered orally.
“A higher relative bioavailability of the medicine implies a larger effective dose for the patient, which may better control symptoms and RA development compared to a lesser dose,” Dr. Piecyk notes.
Patients, on the other hand, are frequently hesitant to administer a self-injection. “I tell patients that the needle is little, that there should be no gastrointestinal side effects, and that if this drug is helpful, they may not need more medication,” Dr. Piecyk explains.
Dr. Bykerk reminds patients that despite methotrexate’s potential for adverse effects such as hair loss and feeling ill, more than 85 percent of patients have few problems with it. If issues arise, patients can always try a different drug. As a result, she believes it’s worthwhile to give it a shot because the advantages exceed the risks. She will usually reevaluate a patient who has started on methotrexate after 8–12 weeks.
“If I notice a positive response, I may propose continuing the treatment or adding other DMARDs.” However, if the response is insignificant and the severe disease burden, I will propose a self-injectable biologic therapy. This necessitates a more in-depth discussion because patients are interested not only in administering injections and learning how to minimize infection risk but also in having an idea of the financial cost.”
According to Dr. Piecyk, self-injectable biologics are becoming more popular as an alternative to intravenous infusions. For example, both abatacept and tocilizumab were previously exclusively available as intravenous infusions. “Many patients would want to make fewer visits to the doctor’s office,” she explains.