COPENHAGEN, June 16 -- Patients with rheumatoid arthritis can safely receive methotrexate at a starting dose of 25 mg per week, it was reported here.
Liver toxicity and other adverse effects of the drug were no worse in patients starting at 25 mg than in others treated conventionally with a low starting dose and gradually increased, reported Sarah Medley, M.B.B.S., of Queen Elizabeth's Hospital in Woolwich, England.
But one patient did develop pancytopenia after receiving the high dose, Dr. Medley said at a poster session here at the European League Against Rheumatism (EULAR) annual meeting.
She undertook the study after some clinicians at the hospital began omitting the traditional dose-escalation approach when putting rheumatoid arthritis patients on methotrexate.
Traditionally, the starting dose is 7.5 or 10 mg per week, which is then gradually raised to 20 or 25 mg over a period of several weeks. Most clinicians believe that such side effects as nausea and myelosuppression are less severe when the drug is started slowly.
But Dr. Medley said many patients fail to increase their weekly doses as instructed and therefore fail to achieve the full clinical benefit of methotrexate.
In addition, many rheumatologists are adopting a "stepdown" approach to early-stage rheumatoid arthritis treatment involving high initial doses intended to achieve rapid disease remission, followed by dose reductions and/or withdrawals.
"This approach would be easier if high doses of methotrexate could be used initially," according to Dr. Medley.
She and two colleagues examined records of 167 rheumatoid arthritis patients who received methotrexate from January 2006 to April 2008.
http://www.medpagetoday.com/MeetingCoverage/EULAR/14733