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Methotrexate use in rheumatoid arthritis. A Clinician's perspective
1Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL 35294, USA. graciela.alarcon@ccc.uab.edu
Immunopharmacology
|July 6, 2000
Summary
Methotrexate (MTX) is a crucial drug for treating rheumatoid arthritis (RA), proving effective in multiple trials. Its use became widespread in the 1990s due to its benefits in managing RA symptoms and disease progression.
Area of Science:
- Rheumatology
- Pharmacology
- Clinical Trials
Background:
- Methotrexate (MTX), initially derived from aminopterine, was first explored for rheumatoid arthritis (RA) treatment in 1951.
- Its use in rheumatology declined with the advent of corticosteroids and cyclophosphamide but re-emerged in the late 1970s-early 1980s due to concerns over the toxicity of alternative treatments.
Purpose of the Study:
- To evaluate the efficacy of methotrexate (MTX) in patients with established rheumatoid arthritis (RA) who had not responded to other treatments.
- To provide evidence supporting the widespread adoption of MTX as a disease-modifying agent in RA management.
Main Methods:
- Conducted four randomized clinical trials (RCTs) comparing MTX to other treatments or placebo in RA patients.
- Performed a meta-analysis of these RCTs to consolidate findings.
- Reviewed historical data and clinical observations regarding MTX use and its comparison to RA's morbidity and mortality.
Main Results:
- Four RCTs by the mid-1980s conclusively demonstrated the beneficial effects of MTX in refractory RA.
- A subsequent meta-analysis supported these findings, leading to FDA approval for RA treatment.
- MTX use became generalized in the 1990s, recognized for managing RA's debilitating effects.
Conclusions:
- Methotrexate is a highly effective treatment for rheumatoid arthritis, particularly in patients resistant to other therapies.
- The evidence from RCTs and meta-analyses solidified MTX's role as a cornerstone therapy in RA.
- The widespread adoption of MTX reflects its favorable risk-benefit profile compared to the disease's own progression.