MTX ACTIVE SUBSTANCE
The active substance methotrexate (MTX) and treatment with MTX for rheumatism, JIA, psoriatic arthritis, psoriasis, or Crohn's disease
You or your child have been prescribed a medicine containing the active substance methotrexate (MTX). MTX is an active substance from the group of so-called immunomodulators. In certain cases, MTX medication can be prescribed by your doctor to treat an autoimmune disease. These include active rheumatoid arthritis, polyarthritic forms of severe, active juvenile idiopathic arthritis, moderate to severe psoriasis, severe psoriatic arthritis or mild to moderate Crohn's disease.
MTX for autoimmune diseases
MTX effect in autoimmune disease In low doses, MTX suppresses the excessively active immune system in an autoimmune disease. The MTX effect here is predominantly anti-inflammatory. As an antagonist of the vitamin folic acid (vitamin B6), methotrexate also blocks various key enzymes of the folic acid metabolism. The cells are hindered in their growth, cell proliferation is stopped.
The treatment of an autoimmune disease with methotrexate is also referred to as ‘low-dose MTX therapy’. In addition to the treatment of autoimmune diseases, methotrexate is also used for the treatment of cancer, although the dosage is 1,000 times higher. Due to the higher dose, other methotrexate side effects are to be expected here.
MTX therapy for psoriasis and MTX for rheumatism
The above-mentioned property is used especially in the treatment of psoriasis: The cell production of the skin is greatly increased in this condition, which can be normalised with MTX treatment for psoriasis. MTX-containing medicines are also often used to treat rheumatism. They belong to a class of medicines known as DMARDs or Disease-Modifying Antirheumatic Drugs. These aim to slow the progression of rheumatism and prevent joint damage.
Before starting MTX treatment
Before starting MTX therapy, your doctor will check whether treatment with methotrexate is an option in your case. This includes checking your blood count and liver and kidney functions. In women of childbearing age, the possibility of pregnancy must be ruled out by suitable examinations before starting MTX treatment. This is because one of the side effects of methotrexate is harm to the unborn child.
During MTX therapy
Even during MTX therapy and six month after stopping MTX, female patients must not become pregnant. Male patients must not father children until 3 months after stopping MTX. For this reason, the consistent use of contraception is necessary for the entire duration of your MTX treatment. In order to detect any methotrexate side effects in good time, you will have regular check-ups and laboratory tests. These are carried out at least once a month during the first six months and at least every three months thereafter.
Favourable balance between MTX effect and MTX side effects
The relatively rapid onset of MTX action after 4 to 8 weeks and a favourable balance between MTX effect and MTX side effects, even in long-term treatment, are some of the reasons why methotrexate is frequently used worldwide as the medicine of first choice for the above-mentioned autoimmune diseases.
MTX tablets or syringes or pre-filled pen?
MTX for rheumatism and other autoimmune diseases can be administered in different ways: as a tablet (oral intake) or as a subcutaneous injection (bypassing the gastrointestinal tract). For the subcutaneous form of application, syringes as well as ready-to-use pens are available, which you can also inject by yourself. Self-injection of MTX for rheumatism and other autoimmune diseases can be an effective way to administer MTX regularly, especially if methotrexate tablets are not well-tolerated or not sufficiently effective. Because of the rapid onset of action, good efficacy and fewer gastrointestinal side effects, subcutaneous injection may offer advantages.
MTX dosing and individual MTX treatment with the metoject® PEN
It is very important that MTX medication is only administered once a week for an autoimmune disease. The MTX dosage is between 7.5 and 30 mg methotrexate per week. Your doctor will decide which dosage is the right one in your individual case.
Fear of needles or injections
The MTX PEN is an autoinjector that contains a single dose of the active substance methotrexate for subcutaneous self-injection. In contrast to the syringe, the subcutaneous injection of the active substance by means of the autoinjector is easier. Therefore, this type of application may also be suitable for people with motor impairments. Since the needle remains hidden during the entire application, the pen can also be suitable for people with a fear of needles or injections.
MTX therapy: for how long?
In order to be able to assess whether MTX therapy is having full effect, it should be continued for several months. If the MTX effect is not sufficient, your doctor will change the dose or the therapy. It is very important that methotrexate is only given once a week.
What to ask about your MTX therapy
You have been prescribed an MTX medication by your doctor. Especially at the beginning of an MTX treatment, a lot of questions can come up. To ensure that you have them ready when you visit your doctor, it can be helpful to make a note of what you want to ask beforehand. We have put together some examples of frequently asked questions and answers.
Patient
"What is methotrexate and for which diseases is it used?”
HCP
"Methotrexate has been prescribed by doctors for over 40 years for the treatment of rheumatoid arthritis. Over the years, it has been used for various autoimmune disorders such as psoriasis and Crohn’s disease. MTX is also used for cancer - but at doses up to 1,000 times higher, which also affects MTX side effects."
"When will I notice that the MTX treatment is working?"
"The MTX effect usually sets in slowly after four to eight weeks. If you don't notice any effect after three months, please bring it up again."
"Where and how do I apply the prescribed metoject® PEN?"
"After a short training session, you can use the metoject® PEN yourself at home. Self-injection takes place once a week as a subcutaneous injection, i.e. under the skin. Suitable parts of the body are the abdominal or thigh region. To prevent skin irritation, please choose a different injection site every week."
"Why do I have to have regular blood checks during MTX therapy?"
"Medicines like methotrexate can change various blood counts. Therefore, these should be checked regularly."
"What is folic acid and why should I take it to accompany my metoject® PEN?"
"Folic acid belongs to the family of B vitamins. It is often given together with methotrexate therapy, as it can have a positive effect on tolerance."
"Why do I need to use contraception during MTX treatment?"
"During MTX therapy, female patients must not become pregnant and male patients must not father children, as the unborn child could be harmed. For this reason, the consistent use of contraception is necessary throughout MTX treatment until six month after stopping MTX. Men must not father children until 3 months after stopping MTX."
"Can I be vaccinated if I am treated with MTX?"
"Standard and booster vaccinations with dead or toxoid vaccines are usually possible during MTX therapy. However, the success of the vaccination cannot be predicted with certainty. For the use of live vaccines, however, therapy would have to be interrupted for a sufficiently long time."
