A study of parenteral use of methotrexate in rheumatic conditions

This paper reports the findings of a small pragmatic study to compare the safety and efficacy of methotrexate administered by intramuscular and subcutaneous injection, and to teach patients to self-administer methotrexate by the subcutaneous route. Eight patients with rheumatic conditions, already receiving a stable weekly dose of methotrexate by intramuscular injection, were entered into this 13-week study. Serum levels of methotrexate were measured on six consecutive occasions: three whilst patients received intramuscular methotrexate and then three after switching to the subcutaneous route. Patients were taught to self-administer their methotrexate subcutaneously and were then discharged to perform this task at home. Levels of disease activity and psychological scores were measured at the start and end of the study. Satisfaction with self-administration and teaching of injection techniques were assessed at 13 weeks. Serum methotrexate levels were not significantly affected by the route of administration. All patients were able to perform self-injection safely and seven out of eight preferred self-administration at home. This small study demonstrates that there is no difference in the safety and efficacy of methotrexate given by either parenteral route. Patients were able to administer safely methotrexate subcutaneously. Self-administration reduced hospital visits, was more convenient for patients and improved patient satisfaction.