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Immunologic Research
Published in: Immunologic Research 2-3/2014

01-12-2014 | PATHOGENESIS AND THERAPY IN AUTOIMMUNE DISEASES

Three decades of low-dose methotrexate in rheumatoid arthritis: Can we predict toxicity?

Authors: Vasco C. Romão, Aurea Lima, Miguel Bernardes, Helena Canhão, João Eurico Fonseca

Published in: Immunologic Research | Issue 2-3/2014

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Abstract

Methotrexate (MTX) is the anchor disease-modifying antirheumatic drug (DMARD) in rheumatoid arthritis (RA) treatment. It is used in monotherapy and/or in combination with other synthetic or biological DMARDs, and is known to have the best cost-effectiveness and efficacy/toxicity ratios. However, toxicity is still a concern, with a significant proportion of patients interrupting long-term treatment due to the occurrence of MTX-related adverse drug reactions (ADRs), which are the main cause of drug withdrawal. Despite the extensive accumulated experience in the last three decades, it is still impossible in routine clinical practice to identify patients prone to develop MTX toxicity. While clinical and biological variables, including folate supplementation, partially help to minimize MTX-related ADRs, the advent of pharmacogenomics could provide further insight into risk stratification and help to optimize drug monitoring and long-term retention. In this paper, we aimed to review and summarize current data on low-dose MTX-associated toxicity, its prevention and predictors, keeping in mind practical RA clinical care.
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Metadata
Title
Three decades of low-dose methotrexate in rheumatoid arthritis: Can we predict toxicity?
Authors
Vasco C. Romão
Aurea Lima
Miguel Bernardes
Helena Canhão
João Eurico Fonseca
Publication date
01-12-2014
Publisher
Springer US
Published in
Immunologic Research / Issue 2-3/2014
Print ISSN: 0257-277X
Electronic ISSN: 1559-0755
DOI
https://doi.org/10.1007/s12026-014-8564-6

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