EULAR and ACR guidelines agree that Methotrexate (MTX) should be the first part of Rheumatoid Arthritis therapy if there is no contraindication As stated in the EULAR guidelines “MTX should be part of the first treatment strategy in patients with active RA… and thus continues to serve as an anchor drug in RA.”
After decades of successful use of MTX the ideal way to optimize MTX is still being discussed.
This presentation will address MTX as the current anchor drug in RA and how to better optimize its dosing for best patient care. Recent EULAR, ACR presentations will be highlighted.
The pharmokinetics will be illustrated from recent Annals of Rheumatic disease papers to help clinicians optimize MTX. Genetic concerns will be addressed and how they might impact the clinical utility and future dosing of MTX.
Ranganathan, P et al: Will pharmacogenetics allow better prediction of methotrexate toxicity and efficacy in patients with rheumatoid arthritis? Ann Rheum Dis 2003;62:4–9
Schiff MH: Future refinement of methotrexate treatment in rheumatoid arthritis: comment on the article by Yazdany et al. Arthritis Care Res (Hoboken). 2013 Nov;65(11):1892. doi: 10.1002/acr.22076.
Schiff MH, Jaffe JS, Freundlich B: Head-to-head, randomised, crossover study of oral versus subcutaneous methotrexate in patients with rheumatoid arthritis: drug-exposure limitations of oral methotrexate at doses ≥15 mg may be overcome with subcutaneous administration. Ann Rheum Dis. 2014 Aug;73(8):1549–51. doi: 10.1136/annrheumdis-2014-205228. Epub 2014 Apr 12.
Yazdany J, Schmajuk G, Robbins M, Daikh D, Beall A, Yelin E, et al. Choosing wisely: the American College of Rheumatology's top 5 list of things physicians and patients should question. Arthritis Care Res (Hoboken) 2013;65:329–39.
Braun J, Kastner P, Flaxenberg P, Wahrisch J, Hanke P, Demary W, et al, for the MC-MTX.6/RH Study Group.Comparison of the clinical efficacy and safety of subcutaneous versus oral administration of methotrexate in patients with active rheumatoid arthritis: results of a six-month, multicenter, randomized, double-blind, controlled, phase IV trial. Arthritis Rheum 2008;58:73–81.
Schiff MH et al: Oral to Subcutaneous Methotrexate. Dose Conversion Strategies in the Treatment of Rheumatoid Arthritis. Oral presentation: ACR 2015.
Müller, R et al: Effectiveness, tolerability, and safety of subcutaneous methotrexate in early rheumatoid arthritis: A retrospective analysis of real-world data from the St. Gallen cohort. Semin Arthritis Rheum. 2015 Aug;45(1):28–34 DOI: http://dx.doi.org/10.1016/j.semarthrit.2015.02.009
Disclosure of Interest None declared