METHOTREXATE AND EMERGING THERAPIES
Section snippets
CHANGE
Thoreau said, “Things do not change; we change.” We have. We have learned a great deal about the molecular nature of mediators of the disease process we call rheumatoid arthritis than we knew when MTX first gained popularity over a decade ago. Researchers have described in exquisite and remarkable detail the structure and function of the major histocompatibility complex (MHC), T cell receptor, and the sequence of molecular signaling events which are necessary for their interaction. Cellular
A NEW ROLE FOR METHOTREXATE
How do these new strategies relate to MTX and what clinical practice patterns are we likely to see emerge? It is of course impossible to predict the future with certainty, but the events of the last several years might allow some reasonable prognostications. Many agents are and will be combined to derive the maximum therapeutic effect. A general consensus has emerged that most patients with moderate or severe RA should be treated aggressively to best avoid the bony destruction, deformity, and
NEW INTERVENTIONS VERSUS METHOTREXATE
As already stated, MTX is not a remission-inducing drug and its use is associated with the potential for serious toxicity. It is possible that any of the new interventions that are now in clinical trials could be found as effective or even more effective than MTX, but without MTX's attendant potential for serious toxicity. At the time this article was written in early 1998, no studies of a therapeutic agent which is equally efficacious to MTX have emerged. Investigations comparing efficacy will
CONCLUSION
The new insights into the molecular basis for disease has led to the development of new therapeutic approaches that will be useful both by themselves and in combination with MTX. It is likely that virtually all of these agents will be used in combination with MTX owing to its present position as the dominant drug used to treat RA, and its demonstrated long-term safety profile. There is also significant potential for new drugs which would hypothetically demonstrate modest or equivalent efficacy
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Cited by (20)
Methotrexate and mortality in patients with rheumatoid arthritis: A prospective study
2002, LancetCitation Excerpt :Deaths from cardiovascular disease, infection, and cancer are increased among individuals with rheumatoid arthritis.1–4 A number of disease-modifying antirheumatic drugs exist, and low-dose methotrexate is the main choice.5 Although results of many clinical trials and their follow-up studies suggest that these drugs, including methotrexate, are effective in reducing morbidity measures (rheumatoid arthritis specific outcomes and relevant quality of life measures), their effect on mortality in patients with rheumatoid arthritis remains unknown.
Triple DMARD combination for rheumatoid arthritis resistant to methotrexate and steroid combination: A single-center experience
2013, Rheumatology InternationalMethylene tetrahydrofolate reductase gene polymorphisms and their association with methotrexate toxicity: A meta-analysis
2012, Pharmacogenetics and Genomics
Address reprint requests to Joel M. Kremer, MD, Department of Medicine, Division of Rheumatology, A-100, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208
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Department of Medicine, Division of Rheumatology, Albany Medical College, Albany, New York