Potential Benefits of the Self-Administration of Subcutaneous Methotrexate with Autoinjector Devices for Patients: A Review

Abstract

The role of patient adherence in improving the efficacy of any treatment is widely accepted, as well as its impact in optimizing the use of healthcare resources and associated costs. Adherence is particularly affected in chronic conditions, such as rheumatoid arthritis (RA), requiring long-term therapies and a commitment of the patient to manage his/her disease. Methotrexate (MTX) is one of the mainstays of treatment for several immune-mediated inflammatory joint and skin diseases, especially RA. The use of parenteral MTX, particularly when administered as a subcutaneous (SC) injection, has recently raised a great interest to overcome the limitations of oral MTX. For addressing this issue, new optimized self-injection systems have been developed to improve the ease of use of SC MTX. Increasing evidence shows how patients tend to opt for autoinjectors over prefilled syringes or conventional syringes in terms of easiness of use, preference and satisfaction, regardless of whether the treatment is a biologic or MTX. Additionally, positive views and beliefs of patients about treatment may contribute to increasing expectations of effectiveness and treatment adherence. Similarly, the implementation of prefilled pens in clinical practice might be a way to facilitate and simplify the self-injection of SC MTX delivery, optimizing adherence and treatment outcomes as a consequence. This article aimed to review the available literature data on the use of MTX autoinjectors and their impact on treatment adherence and patients’ perceptions.

Keywords:

• adherence
• rheumatoid arthritis
• methotrexate
• autoinjector

Abbreviations

ACR/ARHP, American College of Rheumatology’s annual meeting; AUC, area under the curve; CQR, compliance questionnaire rheumatology; DMARDs, disease-modifying antirheumatic drugs; DM2, type 2 diabetes mellitus; EULAR, European League Against Rheumatism; JIA, juvenile idiopathic arthritis; QoL, quality of life; MARS-5, medication adherence report scale; MEMS, medication event monitoring system; MESH, medical subject headings; MPR, medication possession ratio; MTX, methotrexate; RA, rheumatoid arthritis; SC, Subcutaneous; VAS, visual analogue scale; WHO, World Health Organization.

Author Contributions

All authors have substantially (i) contributed to the acquisition, analysis or interpretation of data, (ii) drafted the manuscript and critically revised the manuscript for important intellectual content, (iii) have agreed on the journal which the article will be submitted, (iv) gave final approval of the version to be published, and (v) agreed to take responsibility and be accountable for the contents of the article.

Disclosure

J.T.M has received honoraria from Gebro Pharma and Sanofi. J.C.L.R has received honoraria from Gebro Pharma. N.C.R is an employee of Gebro Pharma, Spain. The authors report no other conflicts of interest in this work.

Additional information

Funding

This Project was funded by Laboratorios Gebro Pharma S.A.