Current and Future Role of Methotrexate in RA Therapy
Current and Future Role of Methotrexate in RA Therapy
According to a recent review, supplementation with FA is an effective measure to reduce hepatic adverse effects associated with MTX treatment. Both FA and folinic acid supplements have been demonstrated to reduce the toxicity of MTX when used in RA therapy. The effect of folate supplementation on MTX efficacy, however, still needs to be studied. FA supplementation has been found to exert a beneficial effect on homocysteine metabolism and may prevent the formation of the less effective metabolite 7-hydroxy-MTX. The cost of FA supplements is substantially less than that of folinic acid supplements.
The latest British Society for Rheumatology guidelines suggested that alcohol consumption by patients treated with MTX should be "well within national limits". However, this is in contrast with the summary of product characteristics for MTX that recommends avoiding alcohol.
Moreover, MTX has to be avoided in patients at risk of liver damage or with pre-existing lung disease. Patient monitoring by means of clinical and laboratory tests prior to and during MTX therapy is necessary to diminish the potential serious toxicities of MTX.
On the other hand, in patients with various comorbidities such as diabetes mellitus, renal failure and obese patients, a lower dose of MTX is used to avoid toxicity and severe adverse events. In addition, patients should be tested for hepatitis B and C before starting MTX treatment. In these conditions, close monitoring is required and DNA viral load should be performed when indicated. Moreover, all patients should be tested for latent tuberculosis before the commencement of MTX treatment. However, there are no international guidelines for tuberculosis prophylaxis in patients treated with MTX.
Prevention of Side Effects
According to a recent review, supplementation with FA is an effective measure to reduce hepatic adverse effects associated with MTX treatment. Both FA and folinic acid supplements have been demonstrated to reduce the toxicity of MTX when used in RA therapy. The effect of folate supplementation on MTX efficacy, however, still needs to be studied. FA supplementation has been found to exert a beneficial effect on homocysteine metabolism and may prevent the formation of the less effective metabolite 7-hydroxy-MTX. The cost of FA supplements is substantially less than that of folinic acid supplements.
The latest British Society for Rheumatology guidelines suggested that alcohol consumption by patients treated with MTX should be "well within national limits". However, this is in contrast with the summary of product characteristics for MTX that recommends avoiding alcohol.
Moreover, MTX has to be avoided in patients at risk of liver damage or with pre-existing lung disease. Patient monitoring by means of clinical and laboratory tests prior to and during MTX therapy is necessary to diminish the potential serious toxicities of MTX.
On the other hand, in patients with various comorbidities such as diabetes mellitus, renal failure and obese patients, a lower dose of MTX is used to avoid toxicity and severe adverse events. In addition, patients should be tested for hepatitis B and C before starting MTX treatment. In these conditions, close monitoring is required and DNA viral load should be performed when indicated. Moreover, all patients should be tested for latent tuberculosis before the commencement of MTX treatment. However, there are no international guidelines for tuberculosis prophylaxis in patients treated with MTX.
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