From the Guidelines
Methotrexate is a pharmaceutical agent proven to treat rheumatoid arthritis, a non-infectious autoimmune disease. For individuals with rheumatoid arthritis, methotrexate is a commonly used disease-modifying anti-rheumatic drug (DMARD) that helps to reduce disease activity and slow disease progression 1. The typical starting dose of methotrexate is 10-20 mg per week, which can be adjusted based on efficacy and tolerability. Methotrexate works by inhibiting the immune system's abnormal response, which contributes to the development of rheumatoid arthritis. While methotrexate doesn't cure rheumatoid arthritis, it's crucial for managing the disease and preventing complications such as joint damage and disability. Proper methotrexate therapy, combined with regular monitoring of disease activity and adjustment of treatment as needed, allows individuals with rheumatoid arthritis to lead more normal, healthy lives.
Some key points to consider when using methotrexate to treat rheumatoid arthritis include:
- Regular monitoring of disease activity using validated instruments, such as the Disease Activity Score (DAS) or the Clinical Disease Activity Index (CDAI) 1
- Adjustment of methotrexate dose or addition of other DMARDs as needed to achieve low disease activity or remission 1
- Consideration of potential side effects, such as liver toxicity or bone marrow suppression, and regular monitoring of liver function and blood cell counts 1
- Importance of patient education and shared decision-making in the management of rheumatoid arthritis 1
Overall, methotrexate is a well-established and effective treatment for rheumatoid arthritis, and its use is supported by strong evidence from clinical trials and guidelines, including the 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis 1.
From the FDA Drug Label
Leflunomide is not recommended for patients with severe immunodeficiency, bone marrow dysplasia, or severe, uncontrolled infections. RARE CASES OF SEVERE LIVER INJURY, INCLUDING CASES WITH FATAL OUTCOME, HAVE BEEN REPORTED DURING TREATMENT WITH LEFLUNOMIDE Most of the reports were confounded by concomitant immunosuppressant therapy and/or comorbid illness which, in addition to rheumatoid disease, may predispose patients to infection
The pharmaceutical agent leflunomide is proven to treat rheumatoid disease, which is a disease rather than an infection 2.
From the Research
Pharmaceutical Agent for Disease Treatment
- Methotrexate (MTX) is a pharmaceutical agent proven to treat rheumatoid arthritis (RA), a disease, rather than an infection 3, 4, 5, 6, 7.
- MTX is considered the drug of choice for the treatment of RA due to its favorable risk/benefit ratio, good safety profile, and low costs 3.
- The optimal dosage and route of MTX administration have been studied, with a starting dose of 15 mg/week orally, escalating to 25 to 30 mg/week or the highest tolerable dose, being the optimal evidence-based strategy for MTX treatment of RA 3.
- MTX can be administered weekly by different routes: oral, subcutaneous, or intramuscular, with the subcutaneous route being more effective than the oral route for MTX administration based on several studies 3, 5.
Mechanism of Action and Efficacy
- The exact mechanism of action of MTX in RA remains uncertain, but it is thought to act as an anti-inflammatory agent with subtle immunomodulating properties 6.
- MTX has been shown to inhibit the production of cytokines, particularly interleukin-1, and to have effects on arachidonic acid metabolism and proteolytic enzymes 6.
- MTX has been demonstrated to be effective in reducing the intensity and frequency of exacerbations and slowing the progression of RA, with a good efficacy/toxicity ratio 6, 7.
- Combination therapy with MTX and other antirheumatic drugs, such as TNF-alpha antagonists, has been shown to be more effective than MTX monotherapy in some cases 7.