Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis

Alfonso E Bello,1 Elizabeth L Perkins,2 Randy Jay,3 Petros Efthimiou4 1Illinois Bone & Joint Institute, Glenview, IL, 2Rheumatology Care Center, Birmingham, AL, 3Arizona Arthritis & Rheumatology Associates, Phoenix, AZ, 4Division of Rheumatology, New York Methodist Hospital, Brooklyn...

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Autores principales:	Bello AE, Perkins EL, Jay R, Efthimiou P
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	bioavailability dosing gastrointestinal polyglutamation subcutaneous Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/950377b773724670a54bb5674e922de1
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spelling	oai:doaj.org-article:950377b773724670a54bb5674e922de12021-12-02T09:07:42ZRecommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis1179-156Xhttps://doaj.org/article/950377b773724670a54bb5674e922de12017-03-01T00:00:00Zhttps://www.dovepress.com/recommendations-for-optimizing-methotrexate-treatment-for-patients-wit-peer-reviewed-article-OARRRhttps://doaj.org/toc/1179-156XAlfonso E Bello,1 Elizabeth L Perkins,2 Randy Jay,3 Petros Efthimiou4 1Illinois Bone & Joint Institute, Glenview, IL, 2Rheumatology Care Center, Birmingham, AL, 3Arizona Arthritis & Rheumatology Associates, Phoenix, AZ, 4Division of Rheumatology, New York Methodist Hospital, Brooklyn, NY, USA Abstract: Methotrexate (MTX) remains the cornerstone therapy for patients with rheumatoid arthritis (RA), with well-established safety and efficacy profiles and support in international guidelines. Clinical and radiologic results indicate benefits of MTX monotherapy and combination with other agents, yet patients may not receive optimal dosing, duration, or route of administration to maximize their response to this drug. This review highlights best practices for MTX use in RA patients. First, to improve the response to oral MTX, a high initial dose should be administered followed by rapid titration. Importantly, this approach does not appear to compromise safety or tolerability for patients. Treatment with oral MTX, with appropriate dose titration, then should be continued for at least 6 months (as long as the patient experiences some response to treatment within 3 months) to achieve an accurate assessment of treatment efficacy. If oral MTX treatment fails due to intolerability or inadequate response, the patient may be “rescued” by switching to subcutaneous delivery of MTX. Consideration should also be given to starting with subcutaneous MTX given its favorable bioavailability and pharmacodynamic profile over oral delivery. Either initiation of subcutaneous MTX therapy or switching from oral to subcutaneous administration improves persistence with treatment. Upon transition from oral to subcutaneous delivery, MTX dosage should be maintained, rather than increased, and titration should be performed as needed. Similarly, if another RA treatment is necessary to control the disease, the MTX dosage and route of administration should be maintained, with titration as needed. Keywords: bioavailability, dosing, gastrointestinal, polyglutamation, subcutaneousBello AEPerkins ELJay REfthimiou PDove Medical PressarticlebioavailabilitydosinggastrointestinalpolyglutamationsubcutaneousDiseases of the musculoskeletal systemRC925-935ENOpen Access Rheumatology: Research and Reviews, Vol Volume 9, Pp 67-79 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	bioavailability dosing gastrointestinal polyglutamation subcutaneous Diseases of the musculoskeletal system RC925-935
spellingShingle	bioavailability dosing gastrointestinal polyglutamation subcutaneous Diseases of the musculoskeletal system RC925-935 Bello AE Perkins EL Jay R Efthimiou P Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis
description	Alfonso E Bello,1 Elizabeth L Perkins,2 Randy Jay,3 Petros Efthimiou4 1Illinois Bone & Joint Institute, Glenview, IL, 2Rheumatology Care Center, Birmingham, AL, 3Arizona Arthritis & Rheumatology Associates, Phoenix, AZ, 4Division of Rheumatology, New York Methodist Hospital, Brooklyn, NY, USA Abstract: Methotrexate (MTX) remains the cornerstone therapy for patients with rheumatoid arthritis (RA), with well-established safety and efficacy profiles and support in international guidelines. Clinical and radiologic results indicate benefits of MTX monotherapy and combination with other agents, yet patients may not receive optimal dosing, duration, or route of administration to maximize their response to this drug. This review highlights best practices for MTX use in RA patients. First, to improve the response to oral MTX, a high initial dose should be administered followed by rapid titration. Importantly, this approach does not appear to compromise safety or tolerability for patients. Treatment with oral MTX, with appropriate dose titration, then should be continued for at least 6 months (as long as the patient experiences some response to treatment within 3 months) to achieve an accurate assessment of treatment efficacy. If oral MTX treatment fails due to intolerability or inadequate response, the patient may be “rescued” by switching to subcutaneous delivery of MTX. Consideration should also be given to starting with subcutaneous MTX given its favorable bioavailability and pharmacodynamic profile over oral delivery. Either initiation of subcutaneous MTX therapy or switching from oral to subcutaneous administration improves persistence with treatment. Upon transition from oral to subcutaneous delivery, MTX dosage should be maintained, rather than increased, and titration should be performed as needed. Similarly, if another RA treatment is necessary to control the disease, the MTX dosage and route of administration should be maintained, with titration as needed. Keywords: bioavailability, dosing, gastrointestinal, polyglutamation, subcutaneous
format	article
author	Bello AE Perkins EL Jay R Efthimiou P
author_facet	Bello AE Perkins EL Jay R Efthimiou P
author_sort	Bello AE
title	Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis
title_short	Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis
title_full	Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis
title_fullStr	Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis
title_full_unstemmed	Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis
title_sort	recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/950377b773724670a54bb5674e922de1
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Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis

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