“The issue of methotrexate is and has been of the highest priority for the FDA, and we’ve been working hard to make sure that patients continue to get the medicine they need when they need it,” writes Patricia El-Hinnawy, a public affairs officer with the FDA, in an email response to questions from Arthritis Today.  

The Impact on Arthritis Patients

Although the impact of the shortage is greatest on cancer patients, arthritis patients around the country are feeling it, too.  

One reason is that “simply switching” from injectable to oral methotrexate isn’t always so simple. “We have switched everyone back to oral methotrexate. Most have done well, but there are some patients that were on injections because they could not tolerate pills – usually [due to] nausea. For these patients, the shortage could be a big problem,” says Leslie J. Crofford, MD, chief of the division of rheumatology at the University of Kentucky, in Lexington.

Some patients who are trying to fill or refill prescriptions for the injectable form are striking out. “We have had some patients from outside our area who [have called us for help because] they have not been able to obtain methotrexate at local pharmacies in some places,” says Eric Matteson, MD, chair of the division of rheumatology at the Mayo Clinic in Rochester, Minn.

People with arthritis in larger cities with many pharmacies may have better luck. “I had a patient who had some difficulty getting her injected methotrexate at her usual pharmacy. However, she was able to find another pharmacy close by that had available stock,” says Jon T. Giles, MD, a rheumatologist and an assistant professor of medicine in the division of rheumatology at Columbia University in New York City.

If you don’t find an alternate pharmacy that has the medication in stock, experts suggest asking your doctor if he or she knows of other suppliers. If not, your best option may be to talk with your doctor about the pills – even if you’ve tried them before and could not tolerate them well. Dr. Giles says there are certain “tricks” that can help, such spreading the pills out over a single day, taking them with food and/or taking them at night.

If the methotrexate shortage continues, and patients are having an especially difficult time on the oral form, alternative treatments – such as other disease-modifying antirheumatic drugs and corticosteroids – may need to be explored.