However, prefilled auto-injection products may be more convenient and easy to use, says Dr. Fradlis.
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“Many of our patients have difficulty drawing up medication from a vial and self-administering subcutaneous methotrexate” due to RA hand involvement or aging, she says. “They may need help with administration, which may not always be available. This may lead to non-compliance as well as frustration,” she says. Auto-injections may be simpler and quicker, she says.
Dr. Coblyn worries about higher costs for these new products. For example, four 25 mg doses of the auto-injected methotrexate range in price from $467–548, while a single 4 mL vial of generic methotrexate at a 25 mg dose costs $5.2,3
“This is more expensive than the way we are doing it already. It may be a niche we needed to fill, but at what cost?” says Dr. Coblyn. Rheumatologists and their patients may look at various options, including splitting oral doses for better absorption or having someone help give patients injections, to achieve effectiveness and avoid the high cost, he says.
Susan Bernstein is a freelance journalist based in Atlanta.
- Braun J, Kästner P, Flaxenberg P, et al. Comparison of the clinical efficacy and safety of subcutaneous versus oral administration of methotrexate in patients with active rheumatoid arthritis: Results of a six-month, multicenter, randomized, double-blind, controlled, phase IV trial. Arthritis Rheum. 2008 Jan;58(1):73–81.
- The Medical Letter. 2014 March 31;Issue 1439.