Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Methotrexate Every Day Is Safe and Effective As Weekly Dosage.
Moreno-Valdes1, Ricardo, Martinez-Martinez1, Marco Ulises, Cuevas-Orta1, Enrique, Alcocer-Varela2, Jorge, Abud-Mendoza3, Carlos
Hospital Central,, San Luis Potosí, Mexico
Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico city, Mexico
Hospital Central y Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosi, Mexico
Most of rheumatologists, under established guides with poor scientific support, emphasized that methotrexate (MTX), in rheumatoid arthritis, should be given weekly at low doses in one day (OD), with apparent less liver toxicity and better tolerance than given every day (ED). Studies have described that C reactive protein levels were lower and more constant with ED dosage. Objective: To compare patients with rheumatoid arthritis (RA) treated with MTX under OD with patients with RA treated with ED scheme.
We analyzed the files of consecutive patients with diagnosis of rheumatoid arthritis according ACR criteria, seen in two Mexican hospital centers. Patients with at least 1 year of disease evolution, treated with stable doses of methotrexate at least in the last 12 weeks were evaluated. Patients were divided into two groups, 80 patients were treated with methotrexate weekly in one day once or in two times with 12 hours between doses (OD or group 1) and 100 patients with low doses every day (ED or group 2). None of our patients were under another DMARD and patients continued taking low doses of steroids (equivalent to 7.5 mg of prednisone or less) and NSAID. We analyzed demographic characteristics, ACR response and disease activity, laboratory tests and adverse events.
We did not find statistical demographic differences in the analyzed groups. Methotrexate dosage was the double in the group 2 with administration every day (equivalent to 2.5 mg/d vs. 1.3 mg/d). Group 2 achieve a better ACR 20, 50 and 70 responses vs. group 1, 81% vs. 60%, 55% vs. 32% and 42% vs. 15% respectively. Hemoglobin levels increased in group 2, and remain in same levels in group 1, C reactive protein and erythrosedimentation rate did not show modifications in group 1 patients, but C reactive protein and ESR diminished 25% and 18.3% respectively. Patients had similar elevation of liver function tests (24 patients in each group, none with 3x or more). Relapses occurred in 47% of patients under OD (Group 1) and in 14% of those with ED therapy (Group 2) (p<0.01). Methotrexate therapy was stopped in 18% of group 1 and in 2% of group 2 because adverse events. We did not find any differences related with glucocorticoid and NSAID doses.
Methotrexate given every day is associated to similar or better efficacy than weekly doses. Lower acute toxicity is founded in every day administration of MTX than when is used weekly. We recognized that is convenient a long and large randomized clinical trial, to define or ratify if methotrexate to diary dosage is as safe and effective as when is used weekly.
To cite this abstract, please use the following information:
Moreno-Valdes, Ricardo, Martinez-Martinez, Marco Ulises, Cuevas-Orta, Enrique, Alcocer-Varela, Jorge, Abud-Mendoza, Carlos; Methotrexate Every Day Is Safe and Effective As Weekly Dosage. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2251