The effect of gender on methotrexate prescription attitudes in Italian rheumatoid arthritis patients: the MARI study

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16

  1. Rheumatology Unit, ASL3 - Regione Liguria, Genoa, Italy.
  2. Rheumatology Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  3. Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy.
  4. Rheumatology and Infectious Diseases Unit, Department of Internal Medicine, Vimercate Hospital, Vimercate, Italy.
  5. Immuno-Rheumatology Unit, AOU “Maggiore della Carità” and IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Novara, Italy.
  6. Pierangeli Clinic, Pescara, Italy.
  7. Department of Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK.
  8. Rheumatology Unit, S. Anna Hospital and University of Ferrara, Italy.
  9. Department of Internal Medicine, Legnano Hospital, Italy.
  10. Rheumatology, Castelli Hospital, Verbania, Italy.
  11. Division of Internal Medicine, Ospedale Civile di Teramo, Italy.
  12. UOS Endocrinology-Rheumatology, AULSS 5 Polesana, Rovigo, Italy.
  13. Rheumatology Outpatient Service, AUSL3 Serenissima, Venice, Italy.
  14. Rheumatology Unit, Vito Fazzi Hospital, Lecce, Italy.
  15. Rheumatology, Istituto Dermopatico dell’Immacolata IDI - IRCCS, Rome, Italy.
  16. Rheumatology Unit, ASL3 - Regione Liguria, Genoa, Italy. gerolamo.bianchi@asl3.liguria.it

CER11868 Submission on line
2019 Vol.37, N°0 - PI 1003, PF 1009
Full Papers

Rheumatology Article



The MARI study investigated the prescription patterns of methotrexate (MTX) in patients presenting with rheumatoid arthritis (RA) in Italy. The primary aims of this cross-sectional analysis from the MARI study were to investigate the effect of gender on the prescription patterns and safety of MTX therapy.
The study enrolled 1336 patients with RA. Retrospective data included patients’ clinical history, previous treatment with MTX and other DMARDs, and MTX modifications in the previous 12-month period. Cross-sectional data included information about current treatment with MTX (dose and route of administration, and adverse events), concomitant medications, disease activity, and modifications of MTX treatment at study entry. The prescription patterns of MTX, rates and causes of MTX modifications were analysed according to gender.
There were no significant differences related to gender in the prescription patterns of MTX, either at 6 months after starting MTX or at the time of study entry. In the 12 months prior to study entry, women (4%) were more likely to undergo MTX modifications (dose or route of administration) compared to men (2%, p=0.032), due to subjective intolerance, but this difference was no longer significant after controlling for confounders. At study entry, a higher proportion of women (27%) reported tolerability issues (nausea and weakness) related to MTX compared to men (14%, p=0.001). Although a similar percentage of males and females changed dose or route of administration of MTX at the time of study entry, the reasons for such modifications were dissimilar between genders. Particularly, a higher proportion of women underwent MTX modification due to intolerance (women 6% vs. men 1%, p=0.002).
In Italy, prescription patterns of MTX do not differ between genders. However, women seem to be at higher risk of adverse events leading to MTX modifications.

PMID: 31172925 [PubMed]

Received: 02/11/2018 - Accepted : 11/02/2019 - In Press: 06/06/2019 - Published: 02/12/2019