The Medical Letter on Drugs and Therapeutics
In Brief: Otrexup - A Single-Use Auto-Injector Formulation of Methotrexate
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The FDA has approved a new injectable formulation of methotrexate (Otrexup – Antares) for use in rheumatoid arthritis and polyarticular juvenile idiopathic arthritis, and for severe psoriasis in adults. On its web site (, the manufacturer states: "Otrexup is the first subcutaneous (SC) methotrexate (MTX) for self-administration delivered once weekly by auto-injector." Methotrexate has been available as a once-weekly injection (IM or SC) for these indications for many years,1 but not specifically for self-administration and not in a single-dose auto-injector. Methotrexate is generally given orally, but injectable formulations may be helpful for patients who have adverse gastrointestinal effects from the oral formulation or lose benefit over time because of poor absorption.

Otrexup auto-injectors are available in strengths of 10, 15, 20, and 25 mg of methotrexate per 0.4 mL. The usual dosage of methotrexate for patients with rheumatoid arthritis ranges from 7.5 to 25 mg once weekly. Otrexup should be administered SC in the abdomen or thigh. Four 25-mg auto-injectors cost $548.00, compared to $5.00 for a single 4-mL vial of generic methotrexate containing 25 mg/mL.2 Nevertheless, some patients with rheumatoid arthritis who find it difficult to draw up methotrexate solution from a vial and inject it with a syringe may prefer Otrexup.

1. Drugs for rheumatoid arthritis. Treat Guidel Med Lett 2012; 10:37.

2. Approximate wholesale acquisition cost (WAC). Source: Analy$ource® Monthly (Selected from FDB MedKnowledge™) March 5, 2014. Reprinted with permission by FDB, Inc. All rights reserved. ©2014. Actual retail prices may be higher.

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