Trends and variation in unsafe prescribing of methotrexate: a cohort study in English NHS primary care

Study (n=7,349 practices) found 1,689 practices prescribed both 2.5 mg and 10 mg tablets to individual patients in 2017, breaching national guidance. Twenty-one deaths caused by methotrexate poisoning were reported from 1993–2017 in England and Wales.

SPS commentary:

Authors state the prevalence of unsafe methotrexate prescribing has reduced but remains common, with substantial variation between practices and CCGs. In April 2018, 697 practices (≥90th percentile) prescribed >14.3% of all methotrexate as 10 mg tablets, likewise breaching national guidance. The 66 practices at ≥99th percentile gave >52.4% 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 of all prescribed methotrexate tablets falling from 9.1% to 3.4%. Authors recommend investment in better strategies around implementation.


British Journal of General Practice