Table 2.
MTX prescribing patterns
| Totala (N = 29) | L‐HDI (n = 15) | MH‐HDI (n = 14) | |
|---|---|---|---|
| Rheumatology indication for prescribing | |||
| Main condition rheumatoid arthritis | 29 (100) | 15 (100) | 14 (100) |
| Secondary conditionsb | |||
| Connective tissue disease | 12 (43) | 7 (50) | 5 (36) |
| Psoriatic arthritis | 12 (43) | 5 (36) | 7 (50) |
| Juvenile idiopathic arthritis | 4 (14) | 2 (14) | 2 (14) |
| Pre‐MTX evaluation | |||
| Lung, liver, kidney, CBCb, c | 28 (97) | 14 (93) | 14 (100) |
| Radiographs done | 17 (59) | 9 (60) | 8 (57) |
| TB screen doned | 18 (62) | 10 (67) | 8 (57) |
| HIV serologies done or available | 16 (55) | 8 (53) | 8 (57) |
| Hepatitis B/C serologies done | 15 (52) | 7 (47) | 8 (57) |
| Pregnancy screen by historyb | 24/28 (85) | 12/14 (86) | 12/14 (86) |
| Alcohol counselling, no/NA/yes | 2/17/10 | 2/9/4 | 0/8/6 |
| MTX dose | |||
| Starting dose, mg/week | 10 (10‐14) | 10 (7.5‐15.0) | 10.0 (10.0‐14) |
| Maximum dose, mg/week | 25 (20‐25) | 20 (15‐25) | 25 (24‐25) |
| Folate prescribed | 24 (83) | 13 (87) | 11 (79) |
| Prescribing challenges | |||
| Cost per month, US dollarse | 17.5 (8.8‐23.5) | 17.0 (7.5‐25.0) | 20.0 (8.8‐223.8) |
| Injectable formulation available | 16 (55) | 8 (53) | 8 (57) |
| Inconsistent MTX supply | 19 (66) | 13 (87) | 6 (43) |
| MTX available in hospital pharmacy | 16 (55) | 4 (27) | 12 (86) |
| Adherence challengesb, f | |||
| Cost and drug availability | 23 (82) | 14 (93) | 9 (64) |
| Lack of prescribers/monitoring ability | 9 (33) | 4 (28) | 5 (38) |
| Patient belief/education/intolerance | 20 (71) | 10 (67) | 10 (77) |
| Patient stigma (hand deformities) | 14 (48) | 9 (60) | 5 (36) |
Abbreviation: CBC, complete blood count; HDI, human development index (2019); HIV, human immunodeficiency virus; L‐HDI, low HDI; MH‐HDI, medium or high HDI; MTX, methotrexate; NA, not applicable due to religion/restricted alcohol access; TB, tuberculosis; US, United States of America.
Connective tissue disease includes lupus vasculitis scleroderma.
Categorical data are reported as n (%); continuous data are reported as median (25th percentile‐75th percentile).
Available for 14 L‐HDI and 14 MH‐HDI countries only.
History, physical examination, and minimal basic laboratory studies done.
TB screen may include physical examination and chest radiograph (interferon γ release assay usually not available).
Estimated cost for MTX 10‐15 mg/week in US dollars.
Main categories reported.