Methotrexate and the treatment of rheumatoid arthritis: an update

Since the approval of methotrexate (MTX) for the treatment of rheumatoid arthritis (RA) 30 years ago, there have been a number of new findings about this drug. As a result, the mode of action is increasingly better understood, new indications are identified and the relevant aspects of patient adherence are defined. In practice, this leads to continued therapy optimisation, especially with regard to the dose and route of administration, which was emphasised at the recent Medac Symposium.

Methotrexate is regarded as the gold standard in rheumatology, due to its efficacy and safety profile for a long period of time. From German register analyses it is known that methotrexate not only demonstrates the highest therapy continuity in RA, but that 60% of adults and 46% of all juvenile idiopathic arthritis (JIA) patients are treated with this drug.


In RA the potential for MTX is far from exhausted, and its key position as the first-line therapeutic agent in the current guidelines are based on its reliable effectiveness in combination therapies and its predominantly manageable side effects. However, a decisive factor for patient compliance is the form of application, where in subcutaneous application of methotrexate, RA patients prefer the Medac autoinjector over the pre-filled syringe.6


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