GPs in England Breaching Guidance on Methotrexate Prescribing

Dawn O'Shea

June 26, 2020

The prevalence of unsafe methotrexate prescribing remains common among GPs in England, according to a new study published in the  British Journal of Medicine .

Because of a number of deaths related the methotrexate overdose across Europe and the UK, the European Medicines Agency (EMA) issued guidance last year to minimise the risk of methotrexate overdose. The guidance recommends that the drug should, usually, only be prescribed in a single-strength 2.5 mg tablet to reduce the risk of harm from errors. The British National Formulary (BNF) advises similarly.

Ben Goldacre and colleagues at Nuffield Department of Primary Care Health Sciences, University of Oxford, carried out a retrospective cohort study of English GP prescribing data from August 2010 to April 2018, and data acquired via freedom of information requests.

The main outcome measures were variation in ratio of non-adherent/adherent prescribing, geographically and over time, between practices and between clinical commissioning groups.

Of 7349 practices in England, 1689 prescribed both 2.5 mg and 10 mg tablets to individual patients in 2017, breaching national guidance. In April 2018, 697 practices (≥90th percentile) prescribed >14.3 per cent of all methotrexate dosages as 10 mg tablets, still breaching national guidance.

The 66 practices at ≥99th percentile gave >52.4 per cent of all prescribed methotrexate in the form of 10 mg tablets.

The prescribing of 10 mg tablets fell during the study period, with 10 mg tablets as a proportion falling from 9.1 per cent to 3.4 per cent.

Twenty-one deaths caused by methotrexate poisoning were reported from in England and Wales between 1993 and 2017.

The authors recommend investment in better strategies around implementation of methotrexate prescribing safety.

MacKenna B, Curtis HJ, Walker AJ, Croker R, Bacon S, Goldacre B. Trends and variation in unsafe prescribing of methotrexate: a cohort study in English NHS primary care. Br J Gen Pract. 2020 Jun 22 [Epub ahead of print]. doi: 10.3399/bjgp20X710993. PMID: 32571771 Full text.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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