PATIENTS’ AND CLINICIANS’ PERSPECTIVES AND EXPERIENCES ON EDUCATION AND SUPPORT ABOUT METHOTREXATE: FINDINGS FROM A SURVEY TO 24 EUROPEAN COUNTRIES

Background Methotrexate (MTX) is the first-line drug in the treatment of rheumatoid arthritis (RA) and many other rheumatic and musculoskeletal diseases (RMDs). It is widely recognized that patients prescribed with this, or other similar drugs, should be properly educated, namely by rheumatology nurses,[1] to better understand why and how to take it, the possible side effects and how to prevent and manage them. However, high disparities may exist across European countries regarding patient education (PE) and support about MTX. Objectives To assess patients’ and clinicians’ perspectives and experiences on education and support received about MTX treatment in Europe. Methods A survey was developed by a team of international researchers and clinicians, including rheumatology nurses (from adult and paediatric care), a pharmacist, a rheumatologist, and patient representatives. Common and sample-specific questions were conceived for adult patients or carers (≥18 years) of children/young with RMDs, nurses, and physicians working in rheumatology in Europe. The survey was available in English and, for patients, in 12 additional languages, disseminated between May and December 2022. Ethics committee approval was obtained (116_CEIPC/2022_IPC). Results Complete responses were obtained from 1536 patients (52% with RA), 154 careers, 335 nurses, and 299 physicians (96% rheumatologists), from 24 European Countries, mainly from Northern (nurses) and Southern Europe (patients and physicians) (Table 1). Only 28% of patients had a specific nurse consultation when they started oral MTX, slightly increasing when the subcutaneous form was prescribed (42%), with variations across Europe, being higher in the Western (43%) and Northern (39%) and lower in Eastern (29%) and Southern (11%). These patients’ perspectives are somewhat in line with physicians’ perspectives, although according to nurses the access to them is higher, independent of the form of prescription (Table 1). Clinicians perceive higher opportunities to discuss patients’ MTX concerns than the patients themselves (Table 1). Patients had more opportunities to voice their concerns (≥7 on a scale from 0 to 10) about MTX before starting it, in Western (57%) and Northern (42%) than in Southern (36%) and Eastern (31%) Europe. According to 47% of nurses, PE occurs on the same day of prescription, with the consultation lasting between 10-30 minutes in 50% of cases or even less than 10’ (15%). 37% of nurses do not perform MTX-related follow-up appointments. Only half of the nurses (49%) received specific training to advise patients about MTX (data not shown). The priority ranking of topics to be addressed was also assessed, with agreement on the top one (side effects and their management) (Figure 1). Around 77% of patients had/have concerns about potential unpleasant side effects, which were discussed with health professionals (mainly with rheumatologists) in 68% of the cases, despite not being clarified 46% of the times. Conclusion PE and support about MTX are unequal across Europe and can be improved by providing opportunities to clarify concerns, namely by providing patients with more access to nursing consultations. There is an overall agreement between patients and clinicians regarding key information areas of education, although a tailored approach is required.