Key findings from studies of methotrexate tapering and withdrawal in rheumatoid arthritis.
Methotrexate is the dominant initial drug in the management of rheumatoid arthritis (RA). Despite its widespread use, methotrexate is associated with a number of adverse effects. Tapering its dose to the minimal amount required to maintain RA remission is, therefore, an important clinical goal. While the complete withdrawal of disease-modifying anti-rheumatic drugs is associated with a definite risk of a disease flare, it is unclear as to what the risk is specific to methotrexate withdrawal and whether this can be minimized by gradual dose reduction (termed 'tapering'). This review examines studies of methotrexate tapering and withdrawal on RA outcomes. It covers three scenarios: tapering/withdrawing methotrexate monotherapy; tapering/withdrawing methotrexate as part of a 'step-down' combination disease-modifying anti-rheumatic drug regimen; and tapering/withdrawing methotrexate when it is being co-prescribed with biologic agents.
a 1 Department of Rheumatology , 4th Floor Tower Wing, Guy's Hospital, London, SE1 9RT, UK.
Sujith
S
Subesinghe
b 2 Department of Medical and Molecular Genetics, King's College London , 8th Floor Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.|c 3 Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation , 1st Floor, New Hunt's House, Guy's Campus, King's College London, Great Maze Pond, London, SE1 1UL, UK.
Ian C
IC
Scott
D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D012074:Remission Induction
D018501:Antirheumatic Agents; D008727:Methotrexate
biologics; disease-modifying anti-rheumatic drugs; methotrexate; outcomes; rheumatoid arthritis; tapering; withdrawal