NRAS
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Methotrexate injections

Hi i know creekybones said that methotrexate has been around for 50 years, Didn't relies it was that long, So has the injection been out just as long?, if not does anyone know how long?, as my brother wasn't given it,

Thanks hugs and xxxx

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62 years actually, MTX was first used in 1950 against various types of cancers and found to be useful for us sometime later. Injections have also been around for a long time, but generally given by nurses in a hospital or surgery setting as in inter-muscular injection so not used so much in RA because of the cost/fuss. It's only been fairly recently (maybe 10 years or so) that the pre-filled syringes became available in a way that allowed people to self inject sub-cutaneously (easier than inter-muscular) and it has really become known that this has lots of advantages. And in some areas, as Tilda's experience shows, it's still considered a bit weird! Polly

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My hospital only offer injections if you can't tolerate the tablet form very well.i.e if it upsets ur tum or you feel sick they will give u injectable mtx,but only after a good old go at tablets !! Xx

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shirl the girl , my point was on the other thread , whenever i get told the outlook is better now for RA with drugs .. i dont see how this can be , when the two main drugs are..

MTX , born 1947 , making it 65 years old

SULFAZALASINE .. even older .. over 70 years old ..

its no better now , then it was for our grandparents ..

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That's what i thought, It didn't seem to make sense to me neither, Well i suppose it wasn't used for RA then, so i suppose that what they mean, as Victoria-NRAS has explained, We always seems to be a bit behind in this country.

Take care X

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Hi Creekybones

I've just left a comment about this on another thread, but think it might be useful here as well, as people often wonder how people can say that things have improved when you largely start out on drugs that have been around for so long. Here's what I've said:

"One further point is that you mentioned that treatments haven't moved on much, as MTX is still the most common drug. This is something that people often say to us, but you have to bear in mind that although the drug is the same, the way in which it's used has changed a LOT over the years. They used to wait until the RA got to a certain level of severity before they treated it with MTX, so the early use of this drug is making it more effective. It is also often given now alongside other mediations, and can complement these other drugs and make them more effective. Also, it used to be one of very few drugs available, so the greater choice has been a big improvement. Lastly, there is a better understanding of the optimal doses for this drug."

Hope that helps add a little clarity.

Kind regards

Victoria

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Thanks this has been really helpfull x

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Hi Shirl

As Helixhelix has said, MTX has indeed been around as a drug since the 1950s. However, it was approved for use in RA in 1988.

In answer to your question about MTX injections, they used to be made up by a pharmacist at the hospital and these were known as 'specials' but as Helixhelix said, this was a lot of hassle and cost for the hospital. The syringes came to the UK in 2006, but at that stage had been used in Europe for several years.

Most RA patients have tablets first, but some will change to injections when they have stomach-related problems, problems with swallowing tablets or if they feel that the injections may be more effective (as they are not dissolving in the body, so you get the full dose).

Hope that helps

Victoria

(NRAS Helpline)

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Thanks this seem to make a bit more sense x

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One more point - my GP looked it up in her book and it seems that while a month's worth of 15mg per week tablets costs £3.50 - each Methoject syringe (from a German pharma company) with the same dosage of MTX costs about £16.50. So in these straightened times this will presumably influence the decision to switch a patient to injectable MTX or not.

Bizzarely - since Polly referred to this earlier - my GPs all shuddered a lot when i first asked about switching to injections and appear to be surprised that I've been able to cope and that it seems more effective?! I'm not sure why this is because I googled it recently and trials were run a few years ago to compare and injectable MTX was found to be significantly more effective than the tablets.

My consultant explained that it's a bit of an issue in my area because there's a shared care protocol between GPs and the rheumatology department in Aberdeen (which also covers my area) and GPs aren't keen to foot the additional costs - but nor is the rheumatology department. But he did say this shouldn't prevent me from going on them and this was sorted for me 3 months ago when my GP emailed him about some weird new symptoms and my persistently raised ESR and it was arranged for me to change to injections. But it's all about money basically. Tilda x

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I can speak from experience ie personal and hospital pharmacy.. what is given to a large extent is governed by budget!.about a year and a half ago I Had to sit in a pharmacy meeting and be told by along with the rest of my colleagues that " we must stop rhematology" using thses expensive drugs refering to injectables of mtx and biologics!, oh and by the way we are cutting out cancer nurse provision to safe money it made me so mad!, no surprise when i asked for enbrel the answer was no!

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Oh my goodness! It's what we all know but to hear an actual examaple of cost-cutting in action is more shocking. Did they even suggest differeent approaches or pursue any reasonable-sounding argument or was it just 'cut costs at all costs'?

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Really shocked to read what Summer said about trying to stop expensive drugs for RA.

Lets look at it from a different angle.

If we are not given these expensive drugs to control our RA we will then have it going rampant in our bodies. This could then lead to expensive stays in hospital for joint replacement operations. We could also be admitted into hospital to try to get it under control i.e. steroid infusions, bed rest. We could end up getting damage to our internal organs (I'm sure we are all aware that it doesn't just effect our joints), the list there is endless, again more costs to the NHS. (Thinking here of those who are on anti tnf's who's RA is judged to be severe.

We would end up on top rate DLA both care and mobility. I do know of one lady who needs people to come to her home to help her with basic day to day task, getting up, dressed etc Whilst I realise that the above two things aren't funded by the NHS all moneys come from the same .pot.

Surely common sense is to get this disease under control in the first instance, this then will save money long term.

Paula

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it means i cant get the more expensive drugs

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I can't agree more, It's all wrong, It would save a lot more money in the long run, Some people i have spoken to friends and my boss they can't believe how long it has taken for me just to get a appointment and start my meds, I've been unable to work since July( and i know some of you have waited longer than that) and am having to claim of the State, If i was seen and put on the correct meds, I would of been able to earn my own money,This would of been a savings, and now the thought of me still not being able to start them , I am having to stay of work another 6 weeks;( As my job is a very demanding and physical job), in the long run, surely giving all of us the best drugs out there, wouldn't just save money, But give us all a peace of mind, Which also would mean i could carry on working for the rest of my life, Than having to try all the lower cost drugs, hoping they will work, and if not taking more time of work........

But then i look at other Country's and think how lucky we are to have any drugs, And tha'ts makes me feel better, But why should will stand for second best, Most people in this country have worked all their lives, Its just not fair,

Well that's my moan for today,

I fill really strong about this subject, Because all i want to do is to go back to work and earn my own money, Than having to use tax money, They need to get this government out, But to be honest' we will properly get some other idiots

Lots of hugs and xxxxxx

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