Background: Patients prescribed subcutaneous methotrexate (S/C-MTX) from our service receive them via a pharmacy delivery company, and self-inject at home. They have regular blood monitoring, which is reviewed by the pharmacy team in our department. As part of a quality improvement project to assess the processes of switching from oral to S/C-MTX, a patient telephone survey was conducted.

Objectives: Our objective was to explore patients’ perceptions of why the switch took place, information received, experience with S/C-MTX, and influence of age, sex and ethnicity on these factors.

Methods: Patients starting in the previous 3 years and currently continuing S/C-MTX were identified from departmental databases. A telephone questionnaire was designed including 11-point (0-10) numerical rating scales (NRS) to rate patients’ experience of: information received; ease of switching; tolerance of injections; and disease control with S/C-MTX. Patients were also asked about the reason for switching & side effects of S/C-MTX. Where not contactable on first telephone call by a Rheumatology senior pharmacist, one more attempt was made. Data were collated on an MS Access database & analysed in SPSS ver27.

Results: Of 101 patients identified, 56 (55.4% response rate) completed the survey. Patients’ recollection of why they were switched included: side effects (n=29, 41%); active disease (n=19, 34%); convenience (n=3, 5.4%); and did not know why they were switched (n=7, 12.7%). NRS (mean±SD) for: quality of information received was 9.00±2.08; ease of switching 9.36±1.15; tolerating S/C injection 8.80±1.70; perceived level of disease control on S/C-MTX 7.94±2.33. There was no significant association of sex or ethnicity with any NRS scores. There was no correlation between age and NRS scores for information received, ease of switching or perceived disease control. However, there was a significant positive correlation between age and tolerating S/C-MTX injections (Spearman’s rho +0.30, P=0.031). On S/C-MTX, 24 patients (43.6%) reported no side effects; one or more side effects were reported by 31 patients (56.4%): hair loss (n=12, 21.8%), abnormal bloods (n=10, 18.2%), nausea/vomiting (n=9, 16.4%), diarrhoea (n=6, 10.9%), & injection site reaction (n=6, 10.9%).

Conclusion: Based on NRS responses, the older the patient, the better they tolerated S/C-MTX, suggesting younger patients may need post-switch monitoring more closely to identify any support needs. Irrespective of age, sex or ethnicity, patients overall rated highly the quality of information received, ease of switching, and perceived level of disease control. Despite this, 12.7% of responders did not know why they were switched, suggesting, a subgroup may need further counseling or information. We therefore recommend verbal counseling is routinely supplemented with printed information and a contact number for any subsequent queries. Also, a high proportion (56.4%) of responders reported at least one side effect, including over a quarter (27%) reporting nausea/vomiting or diarrhoea despite switch to S/C-MTX. In view of this, we recommend further studies to confirm incidence and prevalence of side effects. We also recommend post-switch monitoring to proactively identify those with nausea/vomiting or diarrhea for further investigation or referral.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.