How to Get the Most from Methotrexate (MTX) Treatment for Your Rheumatoid Arthritis Patient?-MTX in the Treat-to-Target Strategy.

Authors:
Peter C Taylor
Peter C Taylor
Kennedy Institute of Rheumatology
United Kingdom
Anne-Barbara Mongey
Anne-Barbara Mongey
University of Cincinnati Medical Center
United States
Jerome Avouac
Jerome Avouac
Université Paris Descartes
France
Hubert Marotte
Hubert Marotte
University of Michigan Medical School
United States

J Clin Med 2019 Apr 15;8(4). Epub 2019 Apr 15.

Division of Rheumatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland.

Methotrexate (MTX) is a remarkable drug with a key role in the management of rheumatoid arthritis (RA) at every stage of its evolution. Its attributes include good overall efficacy for signs and symptoms, inhibition of structural damage and preservation of function with acceptable and manageable safety, a large dose-titratable range, options for either an oral or parenteral route of administration, and currently unrivalled cost-effectiveness. It has a place as a monotherapy and also as an anchor drug that can be safely used in combination with other conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or used concomitantly with biological DMARDs or targeted synthetic DMARDs. MTX is not without potential issues regarding toxicity, notably hepatotoxicity and bone marrow toxicity, as well as tolerability problems for some, but not all, patients. But many of these issues can be mitigated or managed. In the face of a welcome expansion in available targeted therapies for the treatment of RA, MTX looks set to remain at the foundation of pharmacotherapy for the majority of people living with RA and other inflammatory rheumatic diseases. In this article, we provide an evidence-based discussion as to how to achieve the best outcomes with this versatile drug in the context of a treat-to-target strategy for the management of RA.

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Source
http://dx.doi.org/10.3390/jcm8040515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518419PMC

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April 2019
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