Methotrexate...By Mouth Vs. Injection

[theskinyouarein]

Does anyone have information regarding differences in effectiveness with methotrexate when taken by mouth versus by injection? Any info would be helpful. Tks.

[luvwinnie]

When my PA symptoms increased, my rheum. changed me to injections. He said it was more efficient and it did help me.

[theskinyouarein]

Thanks for your prompt response. Do you know if your dose changed (eg increased) or just the route? My son's rheum has suggested that if we don't get a better response w/an increased po dose in 2 months, we should consider injectable form. If that doesn't do it, next stop is enbrel...and that's not something we want to rush into, he's just 8YO...

[JesseLou]

I have no experience with the pills, because my rheumatologist was so certain the injections would be more effective.

Maybe you can ask for your son to go right to injections?

[theskinyouarein]

There was a difference of opinion...the derm basically refused injections for my son (did not want to traumatize him so to speak) and the rheum was pushing for injections. My son very strongly weighed in on the side of pills versus a shot...a second opinion from a derm so no problem w/PO. My son has tolerated the dose (other than transient tiredness). No nausea/vomiting. I would rather try injectable methotrexate than enbrel considering his age...thanks for your response.

[PJ Leary]

Hi,

I know that making informed health decisions as a parent is very difficult, and I understand the concern that causes one to choose medications with more information rather than less. We know a lot about mtx, to be sure. Along with the longer tolerance in juveniles, we also know about the extreme hepatic toxicity issues across all ages.

I wonder how much information you've seen concerning the safety and clinical data on enbrel. In case there is something here you haven't seen, here is a link to about 9 years of data:

http://www.enbrel.com/jra/clinical-experience.jsp

It is important to remember that many of the biologic medications available today for the treatment of both p & pa were first tested for and approved for other diseases.

I am both a patient and a mother, so I understand your worries. I am just suggesting that perhaps you might not have all of the informatio available if you are currently considering mtx to be a safer choice than a biologic like, perhaps enbrel.

Regards,

[bbvb]

Hi,

I can't seem to find the link to the study but I'm pretty sure I read that the injectable form was slightly more effective than the oral (maybe it was on the Johns Hopkins site). Also, the absorption of the oral form of the MTX could vary significantly since it went through the digestive track.

i have seen many posts from people who said the oral form did nothing for them but the injectible worked great. I'm taking the oral form (15mg) and it seems to be starting to work. I'm just starting month 3.......

[luvwinnie]

Thanks for your prompt response. Do you know if your dose changed (eg increased) or just the route? My son's rheum has suggested that if we don't get a better response w/an increased po dose in 2 months, we should consider injectable form. If that doesn't do it, next stop is enbrel...and that's not something we want to rush into, he's just 8YO...

Kept dose the same at first, but then it was increased when my shoulder pain came back.

[web63]

My Rheumy also put me right on the injectable form of MTX.
He said it was much more effective than the pills.
I have been on 1cc of MTX for about 6 years.
I am also up to double doses of Enbrel.
I have tried all of the Bio's at double doses(Remicade, Enbrel and Humira) and have retreated back to Enbrel, because it works best for me.
Good luck.....
BTW: How old is your son?

Thanks,

[theskinyouarein]

Thanks for all your responses. I have found this site to be thought provoking, supportive, informative and reasurring...Unfortunately, when making decisions that may impact for decades to come (my son just turned 8YO) things become much more difficult. I have been reassured, to some degree, from the research I have done on Enbrel, and we've been closely monitoring lab work each month while on MTX. Enbrel, despite its good track record, is still not "been around" long enough fully account for the longer term (20 years out) "what ifs..." at least that is my understanding about new versus more established drugs. Having said that, we have been told the ENBREL is likely to be considered if MTX doesn't have more of an impact in the next few months for my son. One day, one week and one month at a time....I am appreciate for your input...

[lankyloo]

Hi! I see you've gotten alot of responses, but I wanted to share my experience with you. Originally I was taking the pill, and when it got to the max dose (10) it wasn't doing much for my psoriasis. I have PPP, and it's the most difficult of all P's to treat. So I started the injection, and that worked marvelous - for about a year. But that started to not work, so as an experiment I went back on the pills, I'm taking the max dose again, and it's working great.

I think our body gets used to something and then quits working. When I switch off like this every year or two, I get good results.

Good luck!

[theskinyouarein]

Thanks for your f/b. Very interesting to hear how going back and forth between the 2 routes has been effective for you. My son's psoriasis is definitely leveled off or worsened over the last several weeks despite 12.5mg of MTX. We would be much more willing to try injections vs taking the Enbrel plunge. I appreciate your message. Happy Thanksgiving.