Safety Of Low-dose Methotrexate Research Articles

Efficacy And Safety Of Low-Dose Methotrexate In Generalized And Recalcitrant Lichen Planus: A Retrospective Study At A Tertiary Care Center.

Methotrexate (MTX) acts by suppressing multiple immune pathways involved in the pathogenesis of lichen planus (LP). Trials assessing the efficacy and relapse rates of methotrexate in LP are lacking. Our objective was to analyze the efficacy and safety of low-dose methotrexate in generalized and recalcitrant LP patients retrospectively and to assess the relapse rates in patients after stopping MTX therapy. We analyzed clinical and therapeutic details of LP patients treated with low-dose MTX at our center. The cumulative dose and duration of MTX was calculated, and the time to achieve disease control was noted. We analyzed duration of remission and time after which recurrences were seen post-treatment. Records of 42 generalized and recalcitrant LP patients treated with MTX were analyzed. The starting dose of MTX was 7.5 mg (n=7) or 10 mg (n= 35) once weekly, increased to 10/15 mg weekly in patients with inadequate response. Ten patients were lost to follow-up. Complete resolution was achieved in 30/32 (93%) patients within a mean duration of 14.76 weeks (4-32 weeks), and the cumulative dose of MTX to achieve remission was 153.58 mg (50-375 mg). Only minor side effects were noted in 12/32 (37.5%) patients, and none required treatment discontinuation. The mean duration of remission was 29.43 months (5-60 months). MTX demonstrated high efficacy and a good safety profile in extensive cutaneous LP and may be a safer alternative to steroids for this condition.

Low-Dose Methotrexate (LD-MTX) in Rheumatology Practice - A Most Widely Misunderstood Drug

Methotrexate (MTX) was synthesised as a folate antagonist for use in treating childhood leukaemia in 1940s. Gubner and colleagues in 1953 used several log-order lower doses of MTX that mimicked the anti-inflammatory properties of cortisone. They used it successfully in treating rheumatoid arthritis (RA). Their work was however overlooked because the Nobel Prize winning drug cortisone held sway in those days. With increasing awareness of the adverse effects of cortisone, interest was rekindled in discovering 'steroid-sparing' drugs. Hoffmeister and Willkens used low-dose MTX (LD-MTX) in treating RA patients in 1960s with impressive results. Pivotal trials in 1984-5 established the efficacy and safety of LD-MTX in treating RA that gained FDA approval in 1988. LD-MTX at doses <25-30 mg weekly as mini-pulses, is presently the standard-of-care for the treatment of RA. Its toxicities and adverse effects are rarely if ever life-threatening. This is in contrast to the high-dose methotrexate (HD-MTX) for treating malignancies at doses that are several log-orders higher and usually cause serious toxicities. While LD-MTX acts mainly as an anti-inflammatory drug by increasing tissue adenosine levels besides other mechanisms, HD-MTX has anti-proliferative cytotoxic action with different toxicity profile and adverse effects. In practical terms LD-MTX and HD-MTX are 2 different therapeutic agents. However, in developing countries like India the stigma attached to MTX as a cytotoxic 'cancer drug' still persists and most non-rheumatologists fear its use in RA. This review aims to allay such anxiety attached to LD-MTX so that they start using it in appropriate doses for treating RA.

Safety of low-dose methotrexate in elderly recipients supported

Safety of low-dose methotrexate in elderly recipients supported