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Methotrexate in the treatment of rheumatoid arthritis and psoriatic arthritis

https://doi.org/10.26295/OS.2020.12.42.002

Abstract

The article provides data on the place of methotrexate in accordance with international and national recommendations 2019– 2020 in the management of patients with rheumatoid and psoriatic arthritis. Data on the prevalence of these diseases, the effectiveness and tolerability of methotrexate according to randomized controlled and cohort studies are presented. The advantages of the subcutaneous form of methotrexate in terms of efficacy and tolerability for both rheumatoid and psoriatic arthritis are discussed. Data on the tolerance of the subcutaneous form of methotrexate from various manufacturers are presented.

Analysis of literature data and the results of our own research indicate the need for early prescription of methotrexate in patients with rheumatoid arthritis and patients with peripheral joint lesions in psoriatic arthritis.

Numerous studies confirm the effectiveness of methotrexate in rheumatoid arthritis in relation to the symptoms of the disease, both articular and non-articular, structural damage (slowing down X-ray progression), which is accompanied by an improvement in the patient’s functional abilities. With psoriatic arthritis, methotrexate is able to reduce the activity of arthritis, enthesitis, reduce skin manifestations, and improve the functional state of the patient. Treatment with methotrexate, when the clinical effect is achieved, is accompanied by a decrease in cardiovascular complications in inflammatory lesions of the joints. 

About the Authors

N. V. Chichasova
FSBSI V. A. Nasonova Research Institute of Rheumatology
Россия

Doctor of Medicine, Professor,

Moscow



A. M. Lila
FSBEI FPE RMACPE MON Russia Federal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Continuous Professional Education» of the Ministry of Healthcare of the Russian Federation
Россия

Doctor of Medicine, Professor,

Moscow



References

1. Rossiiskie klinicheskie rekomendatsii, Revmatologiya [Russian clinical recommendations. Rheumatology]. Ed. Academician of the Russian Academy of Sciences E. L. Nasonov. Moscow, GEOTAR-Media, 2020, p. 17–57. (In Russ.) URL: http://www.geotar.ru.

2. Ogdie A., Weiss P. The epidemiology psoriatic arthritis // Rheum Dis Clin North Am. 2015; 41 (4): 545–568. DOI: 10.106/j.rdc.2015.07.001.

3. Galushko E. A., Nasonov E. L. Rasprostranennost revmaticheskikh zabolevanii v Rossii [Prevalence of rheumatic diseases in Russia] // Almanakh klinicheskoi meditsiny. 2018; 46 (1): 32–33. (In Russ.) DOI: 10.18786/2072-0505-2018-46-1-32-39.

4. Jadrapai A., Navarro-Millan I. Cardiovascular co-morbidity in patients with rheumatoid arthritis: a narrative review of risk factors, cardiovascular risk assessment and treatment // BMC Rheumatology. 2018, 2: 10. DOI: 10.1186/s41927-018-0014-y.

5. DeMizio D. J., Geraldino-Pardilla L. B. Autoimmunity and inflammation link to cardiovascular disease risk in rheumatoid arthritis // Rheumatol Ther. 2020; 7 (1): 19–33. DOI: 10.1007/s40744-019-00189-0.

6. Labitigan M., Bahče-Altuntas A., Kremer J. M., et al. Higher rates and clustering of abnormal lipids, obesity, and diabetes mellitus in psoriatic arthritis compared with rheumatoid arthritis // Arthritis Care Res (Hoboken). 2014; 66 (4): 600–607. DOI: 10.1002/acr.22185.

7. Johnsson H., McInnes I. B., Sattar N. Cardiovascular and metabolic risks in psoriasis and psoriatic arthritis: pragmatic clinical management based on available evidence // Ann Rheum Dis. 2012; 71 (4): 480–483. DOI: 10.1136/annrheumdis-2011-200567.

8. Coto-Segura P., Eiris-Salvado N., Gonzalez-Lara L., et al. Psoriasis, psoriatic arthritis and type 2 diabetes mellitus: a systematic review and meta-analysis // Br J Dermatol. 2013; 169 (4): 783–793. DOI: 10.1111/bjd.12473.

9. Bhole V. M., Choi H. K., Burns L. C., et al. Differences in body mass index among individuals with PsA, psoriasis, RA and the general population // Rheumatology (Oxford). 2012; 51 (3): 552–556. DOI: 10.1093/rheumatology/ker349.

10. Jamnitski A., Symmons D., Peters M. J. L., Sattar N., McInnes I., Nurmohamed M. T. Cardiovascular comorbidities in patients with psoriatic arthritis: a systematic review // Ann Rheum Dis. 2013; 72 (2): 211–216. DOI: 10.1136/annrheumdis-2011-201199.

11. Smolen J. S., Aletaha D., Bijlsma J. W., et.al. Treating rheumatoid arthritis to target: recommendations of an international task force // Ann Rheum Dis. 2010: 69: 631–637.

12. Smolen J. S., Landewe R. B. M., Bijlsma W. J., et. al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update // Ann Rheum Dis. 2020; 79 (6): 685–699. DOI:10.1136/annrheumdis-2019-216655.

13. Lard L. R.., Visser H.., Speyer I. et al. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies // Amer. J. Med. 2001; 111: 446-451. DOI: 10.1016/s0002-9343(01)00872-5.

14. Pincus T., Yazici Y., Sokka T., et al. Methotrexate as the “anchor drug” for the treatment of early rheumatoid arthritis // Clin Exp Rheumatol. 2003; 21 (Suppl 31): S178–85. https://www.clinexprheumatol.org/article.asp?a=2212.

15. Nasonov E. L., Karateev D. E., Chichasova N. V. Novye rekomendatsii po lecheniyu revmatoidnogo artrita (EULAR, 2013): mesto metotreksata [New recommendations for the management of rheumatoid arthritis (EULAR, 2013): the role of methotrexate] // Nauchno-prakt. revmatologiya. 2014; 52 (1): 8-26. (In Russia). DOI: 10.14412/1995-4484-2014-8-26.

16. Aletaha D., Funovits J., Smolen J. S. The importance of reporting disease activity states in clinical trials of rheumatoid arthritis // Arthritis Rheum. 2008; 58: 2622–2631. DOI: 10.1002/art.23733.

17. Smolen J. S., Landewé R., Bijlsma J., et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease- modifying antirheumatic drugs: 2016 update // Ann Rheum Dis. 2017; 76: 960–977. DOI: 10.1136/annrheumdis-2016-210715.

18. Shea B., Swinden M. V., Tanjong Ghogomi E., et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis // Cochrane Database Syst Rev. 20131; 5: CD000951. DOI: 1002/14651858.CD000951.pub2.

19. Hoekstra M., Haagsma C., Neef C., et al. Bioavailability of high dose methotrexate comparing oral and subcutaneous administration in patients with rheumatoid arthritis // J Rheumatol. 2004; 31 (4): 645–648.

20. Schiff M. H., Jaffe J. S., Freundlich B. Head-to-head, randomised, crossover study of oral versus subcutaneous methotrexate in patients with rheumatoid arthritis: drug-exposure limitations of oral methotrexate at doses ≥15 mg may be overcome with subcutaneous administration // Ann Rheum Dis. 2014; 73 (8): 1549–1551. DOI: 10.1136/annrheumdis-2014-205228.

21. Desmoulin S. K., Hou Z., Candjee A., Matherly L. H. The human proton-coupled folate transporter: biology and therapeutic applications to cancer // Cancer Biol Ther. 2012; 13: 1355-1373. DOI: 10.4161/cbt.22020.

22. Hillson J. L., Furst D. E. Pharmacology and pharmacokinetics of methotrexate in rheumatic disease. Practical issues in treatment and design // Rheum. Dis. Clin. N. Am. 1997, 23, 757–778. DOI: 10.1007/s00296-016-3447-x.

23. Hameed B., Jones H. Subcutaneous methotrexate is well tolerated and superior to oral methotrexate in the treatment of rheumatoid arthritis // Int J Rheum Dis. 2010; 13 (4): e83–e84. DOI: 10.1111/j.1756-185X.2010.01482.x.

24. Bianchi G., Caporali R., Todoerti M., Mattana P. Methotrexate and rheumatoid arthritis: current evidence regarding subcutaneous versus oral routes of administration // Adv Ther. 2016; 33 (3): 369–378. DOI: 10.1007/s12325-016-0295-8.

25. Branco J. C., Barcelos A., de Araújo F. P., et al. Utilization of subcutaneous methotrexate in rheumatoid arthritis patients after failure or intolerance to oral methotrexate: a Multicenter Cohort Study // Adv Ther. 2016; 33 (1): 46–57. DOI: 10.1007/s12325-016-0295-8.

26. Braun J., Kastner P., Flaxenberg P., et al. Comparison of the clinical efficacy and safety of subcutaneous versus oral administration of methotrexate in patients with active rheumatoid arthritis: results of a six-month, multicenter, randomized, double-blind, controlled, phase IV trial // Arthritis Rheum. 2008; 58 (1): 73–81. DOI: 10.1002/art.23144.

27. Harris E., Ng B. Using subcutaneous methotrexate to prolong duration of methotrexate therapy in rheumatoid arthritis // Eur J Rheumatol. 2018; 5: 85–91. DOI: 10.5152/eurjrheum.2018.17113.

28. Yadlapati S., Efthimiou P. Inadequate Response or Intolerability to Oral Methotrexate: Is It Optimal to Switch to Subcutaneous Methotrexate Prior to Considering Therapy With Biologics? // Rheumatol Int. 2016; 36 (5): 627–633. DOI: 10.1007/s00296-016-3447-x.

29. Scott D. G., Claydon P., Ellis C. Retrospective evaluation of continuation rates following a switch to subcutaneous methotrexate in rheumatoid arthritis patients failing to respond to or tolerate oral methotrexate: the MENTOR study // Scand J Rheumatol. 2014; 43 (6): 470–476. DOI: 10.1111/j.1756-185X.2010.01482.x.

30. Bujor A. M., Janjua S., LaValley M. P., Duran J., Braun J., Felson D. T. Comparison of oral versus parenteral methotrexate in the treatment of rheumatoid arthritis: A meta-analysis // PLoS ONE. 14 (9): e0221823. https://DOI.org/10.1371/journal.pone.0221823.

31. Muller R. B., von Kempis J., Haile S. R., Schiff M. H. Effectiveness, tolerability, and safety of subcutaneous methotrexate in early rheumatoid arthritis: a retrospective analysis of real-world data from the St. Gallen cohort // Semin Arthritis Rheum. 2015; 45 (1): 28–34. DOI: 10.1016/j.semarthrit.2015.02.009.

32. Chichasova N. V. Vozmozhnosti dostizheniya maksimalnogo effekta pri kontroliruemom lechenii revmatoidnogo artrita v realnoi klinicheskoi praktike [Possibilities of achieving maximum effect in the controlled treatment of rheumatoid arthritis in real practice]. Lechaschy Vrach. 2015, no. 7: 29–33. (In Russ.) URL: https://www.lvrach.ru-2015/07.

33. Karateev D. E., Luchikhina E. L., Demidova N. V. and others. Primenenie podkozhnoi formy metotreksata dlya lecheniya bolnykh aktivnym revmatoidnym artritom (issledovanie REMARKA)[Application of a subcutaneous form of methotrexate for the treatment of patients with active rheumatoid arthritis (REMARKA study)] // Nauchno-prakt. revmatologiya. 2016; 54 (2): 138–144. (In Russ.) http://dx.DOI.org/10.14412/1995-4484-2016-138-144.

34. Agenova S., Steenberg H. W., van Nies J. A. B., et al. Disease-modifying antirheumatic drug-free sustained remission in rheumatoid arthritis: an increasingly achievable outcome with subsidence of disease symptoms // Ann Rheum Dis. 2016; 75 (5): 867–73. DOI: 10.1136/annrheumdis-2014-207080.

35. Burgers L. E., Huizingal T. W. J., Allaart C. F., van der Helm-van Mill A. H. M. Does treatment strategy influence the ability to achieve and sustain DMARDfree remission in patients with RA? Results of an observational study comparing an intensified DAS-steered treatment strategy with treat to target in routine care // Arthritis Research & Therapy. 2019; 21: 115. https:// DOI.org/10.1186/s13075-019-1893-z.

36. Salliot C., van der Heijde D. Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research // Ann Rheum Dis. 2009; 68 (7): 1100–1104. DOI: 10.1136/ard.2008.093690.

37. Curtis J. R., Beukelman T., Onofrei A., et al. Elevated liver enzyme tests among patients with rheumatoid arthritis or psoriatic arthritis treated with methotrexate and/or leflunomide // Ann Rheum Dis. 2010; 69 (1): 43–47. DOI: 10.1136/ard.2008.101378.

38. Sostman H. D., Matthay R. A., Putman C. E., Smith G. J. Methotrexateinduced pneumonitis // Medicine (Baltimor). 1976; 55 (5): 371–388. DOI: 10.1097/00005792-197609000-00002.

39. Whitcomb M. E., Schwarz M. I., Tormey D. C. Methotrexate Pneumonitis: case report and review of the literature // Torax. 1972; 27 (5): 636–639. DOI: 10.1136/thx.27.5.636.

40. Conway R., Low C., Coughlan R. J., et al. Methotrexate and lung disease in rheumatoid arthritis: a meta-analysis of randomized controlled trials // Arthr Rheum. 2014; 66 (4): 803–812. DOI: 10.1002/art.38322.

41. Rojas-Serrano J., Gonzalez-Velasquez E., Mejia M., et al. Interstitial lung disease related to rheumatoid arthritis: evolution after treatment // Rheumatol Clin. 2012; 8 (2): 68–71. DOI: 10.1016/j.reuma.2011.12.008.

42. Jani M., Dixon W. G., Matteson E. L. Management of the rheumatoid arthritis with interstitial lung disease // Lung disease in rheumatoid arthritis. 2018: 121–161. DOI: 10.1007/978-3-319-68888-6_9.

43. Nasonov E. L. Metotreksat pri revmatoidnom artrite — 2015: novye fakty I idei [Methotrexate in rheumatoid arthritis-2015: new facts and ideas] // Nauchno-prakt. revmatologiya. 2015: 53 (5s): 64–76. (In Russ.) DOI:10.14412/1995-4484-2015-64-76.

44. Gladman D. D., Thavaneswaran A., Chandran V., et al. Do patients with psoriatic arthritis who present early fare better than those presenting later in the disease? // Ann Rheum Dis. 2011; 70 (12): 2152–2154. DOI: 10.1136/ard.2011.1509385.

45. Theander E., Husmark T., Alenius G. M., et al. Early psoriatic arthritis: short symptom duration, male gender and preserved physical functioning at presentation predict favorable outcome at 5-year follow-up. Results from the Swedish Early Psoriatic Arthritis Register (SwePsA) // Ann Rheum Dis. 2014; 73 (2): 407–413. DOI: 10.1136/annrheumdis-2012-201972.

46. Haroon M., Gallagher P., Fitzgerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis // Ann Rheum Dis. 2014; published online Feb 13. DOI: 10.1136/annrheumdis-2013-204858.

47. Gossec L., Baraliakos X., Kerschbaumer A., et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update // Ann Rheum Dis. 2020; 79 (6): 700–712. DOI: 10.1136/annrheumdis-2020-217159.

48. Rossiiskie klinicheskie rekomendatsii. Revmatologiya [Russian clinical guidelines. Rheumatology]. Ed. Academician of the Russian Academy of Sciences E. L. Nasonov. Moscow, GEOTAR-Media, 2020, pp. 101–109. (In Russ.) URL: http://www.geotar.ru.

49. Coates L. C., Kavanaugh A., Mease P. J., et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis // Arthr Rheumtol. 2016; 68 (5): 1060–1071. DOI: 10.1002/art.39573.

50. Elmamoun M., Eraso M., Anderson M., et al. International league of associations for rheumatology recommendations for the management of psoriatic arthritis in resource-poor settings // Clin Rheumatology. 2020; 39 (6): 1839–1850. https://DOI.org/10.1007/s10067-020-04934-7.

51. Kane D., Gogarty M., O’leary J., et al. Reduction of synovial sublining layer inflammation and proinflammatory cytokine expression in psoriatic arthritis treated with methotrexate // Arthritis Rheum. 2004; 50 (10): 3286–3295. DOI: 10.1002/art.20518.

52. Curran S. A., FitzGerald O. M., Costello P. J., et al. Nucleotide sequencing of psoriatic arthritis tissue before and during methotrexate administration reveals a complex inflammatory T cell infiltrate with very few clones exhibiting features that suggest they drive the inflammatory process by recognizing autoantigens // J Immunol. 2004; 172 (3): 1935–1944. DOI: 10.4049/jimmunol.172.3.1935.

53. Kingsley G. H., Kowalczyk A., Taylor H., et al. A randomized placebo- controlled trial of methotrexate in psoriatic arthritis // Rheumatology. 2012; 51 (8): 1368–1377. DOI: 10.1093/rheumatology/kes001.

54. Lie E., van der Heijde D., Uhlig T., et al. Effectiveness and retention rates of methotrexate in psoriatic arthritis in comparison with methotrexate- treated patients with rheumatoid arthritis // Ann Rheum Dis. 2010; 69 (4): 671–676. DOI: 10.1136/ard.2009.113308.

55. Coates L. C., Moverley A. R., McParland L., et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicenter, openlabel, randomised controlled trial // Lancet. 2015; 386 (10012): 2489–2498. DOI: 10.1016/S0140-6736(15)00347-5.

56. Smolen J. S., Schöls M., Braun J., et al. Treating axial spondylarthritis and peripheral spondylarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force // Ann Rheum Dis. 2018; 77 (1): 3–17. DOI: 10.1136/annrheumdis-2017-211734.

57. Loginova E. Yu., Korotaeva T. V., Smirnov A. V., Koltakova A. D., Nasonov E. L. Dostizhenie minimalnoi aktivnosti bolezni I dinamika rentgenologicheskikh izmenenii pri rannem psoriaticheskom artrite cherez god posle nachala lecheniya v ramkakh strategii “Lechenie do ostizheniya tseli” (predvaritelnye rezultaty issledovaniya REMARKA [Achieving minimal disease activity and dynamics of radiological changes in early psoriatic arthritis one year after the start of treatment in the framework of the strategy «Treatment to achieve the goal» (preliminary results of the REMARKA study)] // Nauchno-prakt. revmatologiya. 2017; 55 (6): 610–615. (In Russ.) DOI: 10.14412/1995-4484-2017-610-615.

58. Coates L. C., Fransen J., Helliwell P. S. Defining minimal activity in psoriatic arthritis: a proposed objective target for treatment // Ann Rheum Dis. 2010; 69 (1): 48–53. DOI: 10.1136/ard.2008.102053.

59. Mease P. J., Gladman D. D., Collier D. H., et al. Etanercept and methotrexate as monotherapy or in combination for psoriatic arthritis: primary results from a randomized, controlled phase III trial // Arthritis Rheumatol. 2019; 71 (7): 1112–24. DOI: 10.1002/art.40851.

60. Curtis J. R., Beukelman T., A Onofrei A., et al. Elevated liver enzyme tests among patients with rheumatoid arthritis or psoriatic arthritis treated with methotrexate and/or leflunomide // Ann Rheum Dis. 2010; 69 (1): 43–47. DOI: 10.1136/ard.2008.101378.

61. Wilson T. D., Whittle S. L., Thynne T. R. J., Mangoni A. A. Methotrexate for psoriatic arthritis // Cochrane Database of Systematic Reviews. 2019, Issue 1. Art. No.: CD012722. DOI: 10.1002/14651858.CD012722.pub2.

62. Roubille C., Richer V., Starnino T., McCourt C. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis // Ann Rheum Dis. 2015; 74 (3): 480–489. DOI: 10.1136/annrheumdis-2014-206624.

63. Westlake S. L., Colebatch A. N., Baird J. et al. The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review // Rheumatology. 2010; 49 (2): 295–307. DOI: 10.1093/rheumatology/kep366.

64. Visser K., Katcharmart W., Loza E. et al. Multinational evidence-based recommendations for use methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: intergrading systematic literature research and expert opinion of a board international panel of rheumatologists in the 3E initiative // Ann. Rheum. Dis. 2009, 68 (7): 1086–1093. DOI: 10.1136/ard.2008.094474.

65. Pincus T., Ferraccioli G., Sokka T. et al. Evidence of clinical trials and long-term observational studies that disease-modifying anti-rheumatic drugs slow radiographic progression in rheumatoid arthritis: updating 1983 review // Rheumatol. 2002, 41 (12): 1346–1356. DOI: 10.1093/rheumatology/41.12.1346.

66. Rohr M. K., Mikuls T. R., Cohen S. B., Thorne C. J., O’Dell J. R. The underuse of methotrexate in the treatment of RA: a national analysis of prescribing practices in the U.S. Arthritis Care Res (Hoboken) // Arthr Care Res. 2017; 69 (6): 794–800. DOI: 10.1002/acr.23152.

67. Bello A. E., Perkins E. L., Jay R., Efthimiou P. Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis // Open Access Rheumatol. 2017; 31 (9): 67–79. DOI: 10.2147/OARRR.S131668.s.

68. Hameed B., Jones H. Subcutaneous methotrexate is well tolerated and superior to oral methotrexate in the treatment of rheumatoid arthritis // Int J Rheum Dis. 2010; 13 (4): e83–e84. DOI: 10.1111/j.1756-185X.2010.01482.x.

69. Karateev D. E., Luchikhina E. L., Gridneva G. I., Demidova N. V. Primenenie podkozhnoi formy metotreksata raznykh proizvoditelei v realnoi klinicheskoi praktike: sravnitelnoe issledovanie [Application of subcutaneous forms of methotrexate from different manufacturers in real clinical practice: comparative study] // Almanakh klinicheskoi meditsiny. 2019; 47 (5): 383–392. (In Russ.) DOI: 10.18786/2072-0505-2019-47-055.


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For citations:


Chichasova N.V., Lila A.M. Methotrexate in the treatment of rheumatoid arthritis and psoriatic arthritis. Lechaschi Vrach. 2020;(7):42-51. (In Russ.) https://doi.org/10.26295/OS.2020.12.42.002

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