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Methotrexate access for rheumatoid arthritis in the post-Roe v Wade era

In the wake of the Supreme Court’s decision to overturn Roe v Wade, results of a recent study indicated that more than half of female patients treated with methotrexate, a commonly-prescribed drug used to manage rheumatic diseases, lived in states with abortion restrictions or bans.

Investigators note that these findings emphasize "the magnitude of the potential methotrexate access problem. In the short interval since the ruling, there has been a wide fluctuation in the state-by-state legal status of abortion, which could generate confusion among healthcare providers and potentially affect the accessibility of vital medications for patients with rheumatologic conditions.”

Kazuki Yoshida, MD, MPH, ScD

We sat down with Kazuki Yoshia, MD, MPH, ScD, Director of Rheumatology and Principal Epidemiologist at OM1, to discuss the findings of the study and the next steps for his team.

Rheumatology Network: What were the methods your team used to identify patients treated with methotrexate?

Kazuki Yoshida, MD, MPH, ScD: We used our nation-wide data network (OM1 Real-World Data Cloud) to identify patients who used methotrexate in the last 2 years (n = 139, 288). Among them, we excluded those with cancer and ectopic pregnancy diagnoses. We deemed the remaining users of methotrexate (82%, n = 114,787) as methotrexate users who were using methotrexate for rheumatic and immunological conditions.

RN: Your results stated that in mid-September, approximately half (53%) of patients prescribed methotrexate are residing in states where abortion is banned or restricted. How has this impacted patients/access to the drug?

KY: What we assessed was the distribution of existing methotrexate users. At this point, we have NOT directly studied the ground-level impact on the methotrexate access (for example, prescription declined, reduced use in methotrexate, etc).

RN: What is the clinical significance of your findings?

KY: Our result is important in that (a) we clarified most of the methotrexate use (82%) is for rheumatic and immunological conditions for which continued life-long care is essential and (b) substantial proportion of patients are female (73%, n = 83,517) of whom 23% (n = 19,000) were of reproductive age (and likely to be susceptible to abortion-policy-related methotrexate access issues).

RN: Were there any strengths or limitations that you’d like to discuss?

KY: The strength of our study is the nation-wide nature of our data network, making it possible to quantify the potential impact of this Supreme Court ruling on methotrexate access. The main limitation is that what we studied is the distribution of existing methotrexate users, rather than changes in methotrexate use after the ruling.

RN: Does your team plan on doing any further research on this topic?

KY: One potential direction is to follow the utilization of methotrexate over time before and after the ruling in relation to the state-level policy.

Reference:

Starzyk K, Hoffman V, Su Z, et al. Over Half of Methotrexate Users Reside in States in Which the Overturning of Roe v. Wade Can Jeopardize Access to Medications with Abortifacient Potential [published online ahead of print, 2022 Nov 11]. Arthritis Rheumatol. 2022;10.1002/art.42398. doi:10.1002/art.42398