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Background:In rheumatoid arthritis (RA) and psoriatic arthritis (PsA) methotrexate (MTX) is usually the first choice in the treatment strategy. Bioavailability of oral MTX reaches plateau in doses ≥15 mg weekly, and this is the reason of its lower clinical efficacy.Objectives:The objective of this observational longitudinal study was to evaluate the changes in disease activity, intensity of pain, global health, and physical function when switching from oral (P.O.) to subcutaneous (S.C.) MTX in patients with RA and peripheral form of PsA.Methods:Forty-eight consecutive patients (79.2% women) with established diagnosis of RA (77.1%) and peripheral PsA were enrolled from the outpatient clinics in six centres in Croatia. Median age was 61 (39-79) years, and the median of disease duration was 120 (3-528) months. Data were collected at baseline (T0) including retrospective data collection from the previous 3 months (on P.O. MTX), at day 90 (±10 days) (T1) and at day 180 (±10 days) (T2) for the previous periods, both of them during S.C. MTX treatment. Dose of MTX remained stable during the study. Domains of interest were Disease Activity Score on 28 joints measured using ESR (DAS28-ESR), level of pain, Patent’s Global Health Assessment (PtGHA) and Physician’s Global Health Assessment (PhGHA) were measured on horizontal 100 mm VAS, while physical function was measured by Health Assessment Questionnaire – Disability Index (HAQ-DI).Results:Out of 48 patients 41 patients were switched to S.C. MTX monotherapy and 7 to S.C. MTX in combination with another csDMARD. At T1 40 patients were on S.C. MTX monotherapy and 8 on S.C. MTX in combination with another DMARD, and at T2 39 patients were on S.C. MTX monotherapy, 4 on S.C. MTX in combination with another DMARD, 1 on another DMARD and 4 were lost to follow-up. DAS28 showed trend of decrease from 4.9 at baseline to 4.6 at T1 and 4.2 at T2. Analysis of transition of patients according to DAS28 EULAR criteria has shown that percentage of patients with low disease activity has raised from 4.3% at T0, to 21.7% at T1, and 24.3% at T2, while percentage of patients with high disease activity has declined from 38.3% at T0 to 21.7% at T1 and 13.5% at T2. Recommendation for prednisone therapy > 7.5 mg/QD had 12.5% patients at T0 and T1, and only 6.8% patients at T2. There was a significant decrease in adjusted mean values for level of pain (-1.46; 95%CI -1.55, -0.35), PtGHA (-1.12; 95%CI -1.50, -0.73) and PhGHA (-1.15; 95%CI -1.50, -0.80). HAQ-DI showed significant improvement during the 6-month follow-up (-0.25; 95%CI -0.32, -0.17).Conclusion:Patients who switched from P.O. to S.C. MTX showed improvement in all observed parameters: decrease of disease activity, reduction of pain, better global health, and physical function. Results of our study are in line with previously published literature data.Disclosure of Interests:None declared

Background:It has been demonstrated that bioavailability of oral (P.O.) MTX reaches plateau at doses ≥15 mg QW, and that subcutaneous (S.C.) form has a better efficacy. Alongside with less side-effects this might translate into improvement in quality of life (QoL) and better adherence.Objectives:An academic-induced observational longitudinal study of patients with RA and peripheral form of PsA on csDMARDs who were switched from oral (P.O.) to subcutaneous (S.C.) MTX was conducted. Previously we reported on the better efficacy of S.C. compared to P.O. MTX. The objective of this part of the study we are presenting was to evaluate the 6-month changes in quality of life (QoL), adverse events and adherence in these patients.Methods:Forty-eight consecutive patients (79.2% women) with established diagnosis of RA (77.1%) and peripheral PsA were enrolled from the outpatient clinics in six centres in Croatia. Median age was 61 (39-79) years, and the median of disease duration was 120 (3-528) months. Data were collected at baseline (T0) (on P.O. MTX), at day 90 (±10 days) (T1) and at day 180 (±10 days) (T2), during S.C. MTX treatment. Median dose of MTX remained stable during the study (15mg QW). At each visit QoL was measured using EuroQuol-5D (EQ-5D), adverse events related to MTX use were recorded, and adherence by the number of missed dose.Results:EQ-5D global health assessment showed significant improvement in quality of life of patients on S.C. MTX during the 6 month follow-up (change from T0 to T2 8.6; 95%CI 4.00, 13.3), and the same trend was observed in each of its five component. Number of patients who experienced adverse events related to MTX use has decrease after switching from P.O. to S.C.MTX – from 52.1% during the last 3 months on P.O. MTX to 33.3% during the first 3 months and 18.2% during the last 3 months of S.C. MTX use. During the follow-up adherence to MTX therapy improved, with 25% of patients who missed dose during the last 3 months on P.O. MTX use, to 6,3% and 2.3% with missed dose in the first and the last 3 months on S.C. MTX, respectively.Conclusion:In our group of patients with RA and peripheral PsA who switched from P.O. to S.C. MTX there was a consistent improvement in QoL, less adverse-events and better adherence.Disclosure of Interests:Simeon Grazio Speakers bureau: Abbvie., Roche, MSD, Eli Lilly, Pfizer, Mylan, Amgen, Fresenius Kabi, Stada, Berlin-Chemie, Dijana Perković Speakers bureau: Abbvie., Roche, MSD, Eli Lilly, Pfizer, Mylan, Amgen, Fresenius Kabi, Nadica Laktašić Žerjavić Speakers bureau: Abbvie., Roche, MSD, Eli Lilly, Pfizer, Mylan, Amgen, Fresenius Kabi, Frane Grubisic Speakers bureau: Abbvie., Roche, MSD, Eli Lilly, Pfizer, Mylan, Amgen, Marija Glasnović Speakers bureau: Abbvie, Roche, Pfizer, Ana Gudelj Gračanin Speakers bureau: Abbvie. Roche, MSD, Eli Lilly, Pfizer, Željka Kolak: None declared, Helena Kolar Mitrović: None declared, Jadranka Morovic-Vergles Speakers bureau: Abbvie., Roche, MSD, Eli Lilly, Pfizer, Mylan, Amgen, Fresenius Kabi, Porin Perić: None declared, Petra Šimac: None declared, Iva Žagar Speakers bureau: Abbvie. Roche, MSD, Eli Lilly, Pfizer, Ines Doko Speakers bureau: Abbvie. Roche, Vladimir Trkulja: None declared