Remission Maintained in Some RA Patients on Half The Previous Dosage of
Methotrexate

WESTPORT, Oct 26 (Reuters Health) - A subgroup of patients with rheumatoid arthritis can be maintained in remission with every-other-week methotrexate instead of the standard weekly maintenance schedule.

"Patients with a short disease duration who were treated early after disease onset with weekly [methotrexate] and who achieve sustained remission have a higher probability of success..." with the every-other-week regimen, Dr. Magdalena Luis, of Hospital General de Mexico in Mexico City, and multicenter colleagues report in the October issue of Arthritis and Rheumatism.

The team studied 51 patients who had been treated with weekly methotrexate for at least 9 months and had been in remission for at least 6 months. They were randomized to either continued weekly therapy or to every-other-week treatment, so that their monthly dose was reduced by half.

At 24 weeks, more than 90% of patients in both groups remained in remission by American College of Rheumatology criteria. Patients in the every-other-week group who relapsed were switched back to weekly methotrexate and were again in remission within a few weeks.

Patients randomized to the weekly regimen experienced more adverse events than patients on the every-other-week regimen, but this difference was not statistically significant, Dr. Louis and others report. Serum aspartate aminotransferase and alanine aminotransferase levels were significantly lower at 24 weeks in the every-other-week group compared with the weekly methotrexate group.

The authors suggest that the every-other-week regimen may be able to maintain remission in this select group of rheumatoid arthritis patients by retarding the consumption of polyglutamate reserves. Alternatively, they speculate, rheumatoid arthritis patients who are already in remission may simply "...require lower polyglutamate concentrations to maintain remission."

A potential drawback, Dr. Luis and colleagues note, is that the every-other-week regimen may not prevent continued joint destruction as well as weekly methotrexate. They intend to address this possibility in further studies.

Arthritis Rheum 1999;10:2160-2165.

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