Article Text
Abstract
The use of methotrexate in clinical practice has expanded significantly in recent years, as an effective chemotherapeutic agent as well as disease-modifying treatment for conditions such as rheumatoid arthritis, psoriasis and Crohn’s disease. It is also used as a steroid-sparing agent for a range of inflammatory diseases of the central and peripheral nervous systems. Clinical neurologists must, therefore, know how to start and uptitrate methotrexate, its monitoring requirements and its potential toxicities. This review aims first to explore the evidence base for using methotrexate in various neurological diseases and second to discuss important practicalities around its use, ensuring its safe application and appropriate monitoring.
- CLINICAL NEUROLOGY
- MUSCLE DISEASE
- NEUROMUSCULAR
- NEUROIMMUNOLOGY
Data availability statement
No data are available.
Statistics from Altmetric.com
Data availability statement
No data are available.
Footnotes
X @RobinaCoker1
Contributors AJ: initial draft of the manuscript and subsequent revisions. AB: initial draft of the manuscript and subsequent revisions. SA: review of manuscript and figure creation. RD: specialist neurological pharmacy input. NS: specialist hepatology input and review. RC: specialist respiratory input and review. SV: responsible for care of patient described, concept for paper, review of paper and specialist input on neuromuscular diseases section. AJ and AB contributed equally to the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned. Externally peer reviewed by James Lilleker, Manchester, UK.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
Read the full text or download the PDF:
Other content recommended for you
- Methotrexate polyglutamates in erythrocytes are associated with lower disease activity in juvenile idiopathic arthritis patients
- Pharmacokinetics of oral and subcutaneous methotrexate in red and white blood cells in patients with early rheumatoid arthritis: the methotrexate monitoring trial
- The diagnosis of primary central nervous system vasculitis
- What dose of folic acid to use with methotrexate in rheumatoid arthritis?
- Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative
- Comparison of two dose escalation strategies of methotrexate in active rheumatoid arthritis: a multicentre, parallel group, randomised controlled trial
- Methotrexate polyglutamates in erythrocytes are associated with lower disease activity in patients with rheumatoid arthritis
- A role for methotrexate in the management of non-infectious orbital inflammatory disease
- Adverse events and factors associated with toxicity in patients with early rheumatoid arthritis treated with methotrexate tight control therapy: the CAMERA study
- Leucoencephalopathy with progressive cerebral atrophy