New Canadian recommendations on the use of methotrexate in rheumatoid arthritis focus on routine clinical practice concerns -- ranging from drug interactions to clinical response and patient participation in therapeutic decision-making.
Despite the availability of newer, more effective biologic agents, methotrexate remains an anchor drug for the treatment of rheumatoid arthritis, Wanruchada Katchamart, MD, of the University of Toronto, and colleagues wrote online in the Journal of Rheumatology.
There is considerable variation in the use of the drug among rheumatologists, however, so a multinational initiative was undertaken to formulate evidence-based recommendations to help address practical problems associated with methotrexate use.
The recommendations were formulated by an expert committee consisting of 26 rheumatologists and were derived from a systematic review that included 93 articles from the literature, including meta-analyses, randomized trials, case-control studies, and case reports.
First, the authors stated, the majority of drugs, including nonsteroidal anti-inflammatory drugs, can be used safely in combination with methotrexate, despite reports of cytopenia and liver enzyme elevations. (Grade C Recommendation)
An exception was trimethoprim-sulfamethoxazole, which should be avoided because of the possibility of bone marrow suppression.
In determining an overall treatment strategy for patients with rheumatoid arthritis, clinicians should take into account patient characteristics associated with poor response to methotrexate, the researchers observed. (Grade B Recommendation)
These clinical predictors include:
In addition, important predictors of poor radiographic outcome and joint damage that should be considered were elevated baseline erythrocyte sedimentation rate and other markers of persistent inflammation such as C-reactive protein.
To read the rest of the article: http://www.medpagetoday.com/Rheumatology/Arthritis/21230