The Barriers and Enablers to the Use of Parenteral Methotrexate in Rheumatoid Arthritis Patients: A Scoping Review
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Date
2023
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Tan, J.M.
Reeve, E.
Fraser, L.
Proudman, S.M.
Wiese, M.D.
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Arthritis Care and Research, 2023; 75(11):2306-2315
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Jiun Ming Tan, Emily Reeve, Lauren Fraser, Susanna M. Proudman, and Michael D. Wiese
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Abstract
OBJECTIVES: Methotrexate (MTX) is effective in controlling disease activity in Rheumatoid Arthritis (RA). Parenteral MTX may have benefits over oral MTX, but it is rarely used in practice. To better understand this low usage rate, it is necessary to explore the barriers and enablers of therapy from the perspective of RA patients. The objectives of this scoping review were to describe RA patients' perspectives on the barriers and enablers to the use of parenteral MTX and to identify the research gaps in this field. METHODS: The search was performed in Medline, Embase, Scopus and Cochrane Library from inception to May 2021. Data synthesis was conducted using the Theoretical Framework of Acceptability. This scoping review included any type of study which explored the use of parenteral MTX by adult RA patients from the patients' perspective, written in English. RESULTS: Fifteen studies were included; findings related to the constructs "affective attitude", "burden", "intervention coherence" and "self-efficacy" were explored the most, while some were rarely ("opportunity cost" and "perceived effectiveness") or not ("ethicality") reported. RA patients were generally satisfied with MTX injections ("affective attitude"). From the "burden" construct, the requirement for dexterity for administering MTX by injection was considered a barrier, whereas the lack of significant pain from MTX injection was considered an enabler. CONCLUSIONS: The findings suggested that patients generally preferred parenteral MTX formulations with attributes that facilitate self-administration. However, much of the identified research focused on prefilled pen devices, and significant gaps were identified, such as a lack of qualitative research. This article is protected by copyright. All rights reserved.
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© 2023 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.