Methotrexate re-use in rheumatoid arthritis is frequently effective despite earlier failures

A second course of methotrexate, the most commonly used drug to treat rheumatoid arthritis, is effective in nearly half of studied patients for whom a previous treatment with the drug was ineffective.

These are the results of a study published in Arthritis Research & Therapy, which also shows that a second treatment with methotrexate is particularly effective in patients who were given low dose methotrexate in their first treatment.

Theresa Kapral and colleagues from the Medical University of Vienna, Austria recruited patients with rheumatoid arthritis who had had at least two treatments with an anti-arthritis drug.

Kapral et al. identified 79 patients who had had a second methotrexate treatment lasting at least a year. The patients had terminated the first treatment either because it was ineffective or because of adverse events. Forty-two (53.2%) patients had an effective second treatment. The second treatment was effective in 23 (45.1%) of the patients who had stopped treatment because of inefficacy. Sixteen (66.7%) of the patients who had initially stopped treatment because of adverse events had a successful second treatment. The second treatment was more than twice as likely to be successful if the methotrexate dose in the first treatment had been low (lower or equal to 10mg per week) than if it had been high (greater than 17.5mg per week). There was no difference in efficacy between first and second treatment for other anti-arthritis drugs.

Physicians treating rheumatoid arthritis are in need of therapeutic options especially for patients with a history of repeated drug failures. The results of this study indicate that renewed institution of methotrexate might be one option that could be considered for the treatment of these patients.

Arthritis Research and Therapy 2006, 8: R46 (doi:10.1186/ar1902)