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Gene-body mass index interactions are associated with methotrexate toxicity in rheumatoid arthritis
  1. Stella Aslibekyan1,
  2. Jin Sha1,
  3. David T Redden2,
  4. Larry W Moreland3,
  5. James R O'Dell4,
  6. Jeffrey R Curtis5,
  7. Ted R Mikuls4,
  8. Richard J Reynolds1,
  9. Maria I Danila5,
  10. S Louis Bridges Jr5
  1. 1Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  2. 2Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittburgh, Pennsylvania, USA
  4. 4University of Nebraska Medical Center, Omaha, Nebraska, USA
  5. 5Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Stella Aslibekyan, Departments of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 230J, Birmingham, AL 35294, USA; saslibek{at}

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Despite the introduction of multiple biological agents for the treatment of rheumatoid arthritis (RA), methotrexate (MTX) remains the initial drug of choice.1 Response to MTX therapy is highly heterogeneous between individuals. An extensive body of work illustrates the complexity of MTX response architecture, which includes genetic polymorphisms, environmental factors and gene-gene interactions.2 Among environmental contributors, elevated body mass index (BMI) has emerged as an important predictor of MTX toxicity.3 Using data from the Treatment of Aggressive Rheumatoid Arthritis (TEAR) trial,4 we present first evidence linking the risk of MTX-associated toxicity to interactions between genotype and BMI.

The TEAR trial, described in previous publications,4 compared two strategies (early intensive …

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