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During the past 3 decades, methotrexate has become the anchor drug for rheumatoid arthritis (RA) therapy because of its efficacy, tolerability, and affordability. In clinical trials, 30% of RA patients achieve low disease activity with methotrexate monotherapy, thus avoiding the need for high-cost biologic therapies. Because subcutaneous methotrexate is more effective than once-weekly oral dosing, a trial of subcutaneous methotrexate should be considered before adding a biologic therapy. To determine if methotrexate is used suboptimally in some patients who switch to biologics, investigators (supported by a manufacturer of subcutaneous methotrexate) analyzed data from a U.S. health insurer.
A total of 35,640 treatment-naive patients started …