The Pharmaceutical Benefits Advisory Committee has approved pre-filled syringes for subcutaneous administration of methotrexate (Trexject) for the treatment of rheumatoid arthritis when oral methotrexate is unsuitable.

The approval at their March meeting overturns a 2016 decision rejecting the application due to concerns about cost minimisation with the 50mg vial of methotrexate.

However the latest decision has confirmed the clinical need for the product and accepted that the cost of Trexject will be offset by reduced administration costs.

Sydney rheumatologist Dr Irwin Lim became an advocate for injectable methotrexate after attending last year’s EULAR meeting. He used his blog to encourage readers to submit their opinions and comments to PBAC earlier this year.

He argued that injectable methotrexate was more bioavailable than the oral form and associated with potentially lower side effects.

He also said that the TGA listing of Trexject without PBAC approval had led to the unintended consequence of discouraging compounding pharmacists from preparing methotrexate syringes for patients.

“This has led to more inconvenience for my patients with many now attending their GP practices for GPs and/or nurses to draw up their methotrexate from vials to then deliver the injection. This leads to wasted time and increased costs for Medicare,” he wrote in his blog.

Trexject is available in 7.5, 10, 15, 20 and 25mg doses in 0.15, 0.2, 0.3, 0.4 and 0.5 mL pre- filled syringes.

The PBAC approval is also relevant to patients with psoriasis.