Many patients with rheumatoid arthritis in the UK are now benefiting from the use of subcutaneous methotrexate either alone or in combination with anti-TNF’s. Recent clinical evidence suggests that rheumatologists can often defer the use of anti-TNF’s (with consequent substantial cost savings) by maintaining patients for longer on methotrexate(1). Other studies suggest subcutaneous methotrexate has greater bioavailability(2) and demonstrates a better GI side effects profile(3) than oral methotrexate. Now a 10mg/mL pre-filled syringe (Metoject) has been licenced in the UK and is available in five doses – 7.5, 10, 15, 20 and 25mg. The Royal College of Nursing has recently published a guidance document entitled ‘Administering subcutaneous methotrexate for inflammatory arthritis’ (4). The Commission for Health Improvement expects NHS staff to use this guidance to shape the delivery of care to its patients.
The RCN document highlights the following key messages:
- Use pre-dosed, pre-filled syringes of methotrexate
- Use the subcutaneous route of drug administration
- Introduce risk management policies to reduce the potential risks associated with spillages
- Ensure patients are fully informed about methotrexate therapy so that they can make informed decisions
- Ensure the provision of appropriate protective equipment to facilitate safe drug administration, for both carers and patients.
- Ensure the implementation of an effective clinical waste collection policy
Central Homecare ’s home rheumatology service meets all the requirements of the RCN guidelines. To assess patient competency in administering subcutaneous injections, please download this form: Patient Competency Checklist. To download the Injection site document, please click here.
Please note that in addition to methotrexate, Central Homecare can also provide a comprehensive range of anti-TNF drugs.
Methotrexate and Anti-TNF Prescription Requirements Form (Secure area, please login or signup to enter)
Metoject: Abreviated prescribing information
How to order a Metoject home care package
How to order Metoject wholesale
References:
(1) Bingham S.J., Buch M.H., Tennant, A. and Emery, P. Rheumatology 2004; 43: 364-368
(2) Hoekstra M., Haagsma C., Neef C., Proost J., Knuif A. and van de Laar, M. The Journal of Rheumatology 2004; 31(4):645-648
(3) Russo R.A.G. and Katsicas M.M. Clin. Exp.Rheumatol. 2000; 18: 425
(4) Published in 2004 by the Royal College of Nursing, 20 Cavendish Square , London W1G 0RN