Optimization of methotrexate treatment in rheumatoid arthritis therapy
Authors:
K. Pavelka
Authors place of work:
Revmatologický ústav Praha
Published in the journal:
Čes. Revmatol., 28, 2020, No. 1, p. 16-22.
Category:
Review Article
Summary
The aim of this review is to assess the position of methotrexate (MTX) in a modern strategy for the treatment of active rheumatoid arthritis. It has been noted that MTX is not used adequately in routine clinical practice, neither in frequency, dose and possible forms of administration. As recommended by EULAR (European League Against Rheumatism), MTX should always be part of the first treatment strategy. It can also be an anchor drug when other synthetic or biological drugs are added to MTX in case of inadequate response. More recently, the combination of MTX with glucocorticoids has been shown to be beneficial in initiating treatment for early rheumatoid arthritis. The dose of 10 mg MTX per week with rapid titration to 25–30 mg per week is recommended as an initial dose. With rapid dose escalation, up to 40% of patients can achieve low disease activity status. MTX is always given in combination with folic acid. The problem of oral MTX is non-constant absorption, especially at doses higher than 15 mg per week. It is, therefore, preferable to switch to subcutaneous administration of MTX. A meta-analysis of 7 studies showed greater efficacy of subcutaneous MTX than oral. Subcutaneous administration also results in a faster onset of action. It has also been shown that switching to subcutaneous MTX can reduce the need for biological treatment by up to 20%, making it a pharmacologically advantageous procedure. Subcutaneous MTX is currently available, with autoinjectors in the form of pre-filled pens being particularly preferred.
Keywords:
Methotrexate – rheumatoid arthritis – subcutaneous methotrexate
Zdroje
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Štítky
Dermatology & STDs Paediatric rheumatology RheumatologyČlánok vyšiel v časopise
Czech Rheumatology
2020 Číslo 1
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