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. 2024 May 20;10(2):e004024.
doi: 10.1136/rmdopen-2023-004024.

Urinary methotrexate dosage in rheumatoid arthritis, in patients treated for at least 6 months: a potential marker of adherence

Noémie Théate  1   2 , Marion Geoffroy  2 , Lukshe Kanagaratnam  3   4 , Claire Gozalo  5   6 , Isabelle Charlot  2 , Lois Bolko  2 , Ambre Hittinger-Roux  2 , Zoubir Djerada  5   6 , Jean-Hugues Salmon  7   2
Affiliations

Urinary methotrexate dosage in rheumatoid arthritis, in patients treated for at least 6 months: a potential marker of adherence

Noémie Théate et al. RMD Open. .

Abstract

Objectives: Non-adherence to rheumatoid arthritis (RA) treatments must be identified. A methotrexate (MTX) urinary dosage (METU) was recently developed. The aim of our study was to assess adherence to MTX in RA using METU in real-life conditions and to compare it with indirect adherence measurement technics.

Methods: We performed a cross-sectional study at Reims University Hospital. We included over 18-year-old patients with RA treated by MTX for more than 6 months. Patients were invited to complete demographic, clinical and psychological questionnaires and adherence measurement technics (Compliance Questionnaire of Rheumatology (CQR) and Medication Possession Ratio (MPR)). A urinary sample was collected to measure MTX and information about tolerance was evaluated through Methotrexate Intolerance Severity Score.

Results: 84 patients were included, 26 using oral MTX, 58 subcutaneous (SC) MTX. Among them, 73% were female, mean age was 61.5 years, MTX mean dose was 15 mg/week and 61.9% were treated by biological DMARDs (Disease Modifying Antirheumatic Drugs). 77 patients (91.7%) were adherent to treatment according to METU, whereas MPR and CQR reported less adherence (69.5% and 61.9%, respectively). MPR and METU were not significantly different in SC MTX users (p=0.059). Non-adherent patients had a higher number of tender joints and C reactive protein value (p<0.05).

Conclusion: This is the first largest study evaluating MTX adherence in patients with RA using a urinary dosage. We identified that indirect adherence measurements did not reflect real-life adherence. It would be appreciable to realise METU, in a new study, in patients with RA with unexplained response to treatment, to consider it before escalating therapeutic strategy.

Keywords: methotrexate; pharmacokinetics; rheumatoid arthritis; sensitivity and specificity; therapeutics.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. Flowchart. MTX, methotrexate.
See this image and copyright information in PMC

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