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

Author

Taylor PC1, Balsa Criado A2, Mongey AB3, Avouac J4, Marotte H5, Mueller RB6. J Clin Med. 2019 Apr 15;8(4). pii: E515. doi: 10.3390/jcm8040515.

Author Information

1 Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford OX3 7LD, UK. peter.taylor@kennedy.ox.ac.uk.

2 Rheumatology unit, University Hospital La Paz, Institute for Health Research?IdiPAZ, Universidad Autonoma de Madrid, 28046 Madrid, Spain. alejandro.balsa@salud.madrid.org.

3 St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. anne.b.mongey@ucd.ie.

4 Paris Descartes University, Sorbonne Paris Cité, Rheumatology Department, Cochin Hopital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France. javouac@me.com.

5 SAINBIOSE, INSERM U1059, Université de Lyon, Saint-Etienne, France Service de Rhumatologie, CHU Saint-Etienne, 42055 Saint-Etienne, France. Hubert.marotte@chu-st-etienne.fr.

6 Division of Rheumatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland. ruediger.mueler@ksa.ch.

Abstract

Abstract

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.