In a nutshell
The authors aimed to analyze the safety and effectiveness of increasing doses of methotrexate (Trexall) in combination with adalimumab (Humira) in early rheumatoid arthritis (RA). The authors found out that increased doses of methotrexate resulted in improved outcome in RA.
Some background
In RA, the immune system begins attacking healthy tissues the way it normally attacks viruses or bacteria. This can cause inflammation, leading to chronic pain. Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate are safe, effective and primary treatment options for RA. Tumor necrosis factors (TNF) are a group of proteins involved in the inflammation process in RA. Anti-TNF treatment blocks the action of TNF and prevents inflammation. Adalimumab is an example of biological anti-TNF treatment. The combination of adalimumab plus methotrexate has been shown to be more effective than adalimumab only treatment in RA patients.
It will be beneficial to find out the appropriate dose of methotrexate in combination treatment with adalimumab and the risks associated with it.
Methods & findings
The authors aimed to assess the effectiveness and safety of increasing doses of methotrexate in combination with adalimumab in RA.
395 patients with early RA were included in this study. The patients had not been previously treated with methotrexate. Patients were randomly assigned to receive 40 mg of adalimumab every other week. They also received 2.5, 5, 10, or 25 mg of methotrexate weekly for 26 weeks. Improvements in disease activity were measured after 26 weeks.
42.9% of patients receiving 2.5 mg of methotrexate showed improvements in disease activity. For patients receiving 5 mg of methotrexate, 44% saw improvements. Improvements in disease activity were seen in 56.6% of patients receiving 10 mg and 60.2% of those receiving 20 mg of methotrexate.
No significant differences in physical function were observed with increased doses of methotrexate. There were no significant differences between 10 and 20 mg/week doses of methotrexate for achieving faster reduction of symptoms and lower disease activity.
Abnormal hair loss and infections occurred with increasing doses of methotrexate.
The bottom line
The authors concluded that higher doses of methotrexate in combination with adalimumab showed improved outcomes in RA patients.
What’s next?
Please discuss what medication doses may be appropriate with your doctor.
Published By :
Annals of the rheumatic diseases
Date :
May 29, 2015
