# Methotrexate Shortages and Their Impact on Chronic Inflammatory Rheumatic Disease Management: Results From a National Survey of Moroccan Rheumatologists

## TL;DR

This study shows how methotrexate shortages in Morocco are affecting the treatment of chronic rheumatic diseases and leading to more expensive and less effective alternatives.

## Contribution

The paper provides new insights into the real-world impact of methotrexate shortages on rheumatology practice and patient outcomes in Morocco.

## Key findings

- 98.7% of rheumatologists consider methotrexate the preferred treatment for chronic inflammatory rheumatic diseases.
- MTX shortages led to increased corticosteroid use, hospitalizations, and biologic therapy in patients.
- 97.4% of rheumatologists reported difficulties in prescribing MTX due to stock shortages.

## Abstract

Objective: To assess the impact of methotrexate (MTX) shortages on the management of chronic inflammatory rheumatic diseases (CIRD) in Morocco and their consequences on patient care.

Material and methods: We conducted a cross-sectional online survey among Moroccan rheumatologists. A structured Google Forms (Google Inc., Mountain View, CA, USA) questionnaire was emailed to rheumatologists, divided into five sections: sociodemographic data, MTX indications and prescription methods, patient-reported reasons for stopping MTX, consequences of stopping MTX, and possible solutions.

Results: The survey was completed by 153 rheumatologists (mean age 42.9 ± 12.7 years, 84.8% female, mean length of practice 13.8±11 years). Overall, 98.7% considered MTX as the conventional disease-modifying antirheumatic drug (cDMARD) of choice for treating CIRD, with 84.3% prescribing it primarily for rheumatoid arthritis. The main reason for MTX discontinuation was unavailability of treatment (96.1%), and 97.4% of rheumatologists reported difficulties in prescribing due to recurrent stock shortages. Consequences included increased use of higher daily doses of oral corticosteroids (94%), higher rates of hospitalization for corticosteroid bolus infusions (79%), therapeutic escalation to biologics in biologic-naïve patients (67.3%), and reduced effectiveness of current biologic therapy (44.6%).

Conclusion: This survey highlights the significant impact of MTX shortages on CIRD management, driving reliance on expensive biologics and deteriorating patients’ and families’ quality of life. Urgent action is needed to ensure a continuous MTX supply.