Systematic review of recommendations on the use of methotrexate in rheumatoid arthritis

Valerio, Valeria; Kwok, Michelle; Loewen, Hal; Winkler, Janice; Mody, Girish M.; Scuccimarri, Rosie; Meltzer, Michele; Mengistu, Yewondwossen; Feldman, Candace H.; Weinblatt, Michael E.; Lacaille, Diane; Hitchon, Carol; Colmegna, Inés

doi:10.1007/s10067-020-05363-2

Cited by 12 publications

(10 citation statements)

References 23 publications

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“…This uncertainty is compounded by a lack of local data on some of these aspects. Many guidelines recommend screening for HIV and avoiding MTX in the setting of active hepatitis B or C and untreated or latent TB ( 6 , 32 ). However, there is no consensus regarding the duration of TB treatment needed prior to starting MTX, the risk of isoniazid hepatitis, or the use of MTX in the setting of treated HIV.…”

Section: Discussionmentioning

confidence: 99%

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Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Hitchon

Mody

Feldman

et al. 2021

ACR Open Rheumatology

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Objective Guidelines for methotrexate (MTX) use in rheumatic disease may not be feasible for physicians practicing in the least developed countries. We aimed to understand the experiences of MTX prescribers relating to MTX use for rheumatic disease in African countries to inform the development of culturally and geographically appropriate recommendations. Methods African physicians who self‐identified as MTX prescribers from countries classified as having a low versus a medium or high Human Development Index (L‐HDI versus MH‐HDI) participated in semistructured interviews between August 2016 and September 2017. Interviews were transcribed verbatim, coded thematically, and stratified by HDI. Results Physicians (23 rheumatologists; six internists) from 29 African countries were interviewed (15 L‐HDI; 14 MH‐HDI). Identified barriers to MTX use included inconsistent MTX supply (reported by 87% L‐HDI versus 43% MH‐HDI), compounded by financial restrictions (reported by 93% L‐HDI versus 64% MH‐HDI), patient hesitancy based partly on cultural beliefs and societal roles (reported by 71%), few prescribers (reported by 33%), prevalent infections (especially viral hepatitis, tuberculosis, and human immunodeficiency virus), and both availability and cost of monitoring tests. MTX pretreatment evaluation and starting and maximal doses were similar between L‐HDI countries and MH‐HDI countries. Conclusion The challenges of treating rheumatic disease in African countries include unreliable drug availability and cost, limited subspecialists, and patient beliefs. Adapting recommendations for MTX use in the context of prevalent endemic infections; ensuring safe but feasible MTX monitoring strategies, enhanced access to stable drug supply, and specialized rheumatology care; and improving patient education are key to reducing the burden of rheumatic diseases in L‐HDI countries.

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Section: Discussionmentioning

confidence: 99%

“…Clinical experience is required to use MTX safely. Existing guidelines vary regarding recommendations for MTX prescribing and monitoring ( 6 ). Moreover, it is unknown whether those guidelines are adequate to inform MTX use in resource‐poor regions ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Hitchon

Mody

Feldman

et al. 2021

ACR Open Rheumatology

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“… Sickness, numerous blood disorders, ulcers, mouth disorders and nausea. ( Valerio et al, 2021 , Guo et al, 2021 ) Myocrisin (GSTM), Auranofin Acts via inhibiting production of pro-inflammatory cytokines. Forms a complex with cysteine protease which prevents bone resorption and process of antigen presentation Mouth ulcers, blood disorder, kidney disorders, skin rashes, sore throat.…”

Section: Future Prospective: Therapeutic Approaches On Inhibiting the Action Of Cathepsinmentioning

confidence: 99%

Exploring the role of cathepsin in rheumatoid arthritis

Behl

Chadha

Sehgal

et al. 2022

Saudi Journal of Biological Sciences

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Rheumatoid arthritis (RA) is a chronic inflammatory disease which is marked by leukocytes infiltration inside synovial tissue, joints and also inside synovial fluid which causes progressive destruction of joint cartilage. There are numerous genetical and lifestyle factors, responsible for rheumatoid arthritis. One such factor can be cysteine cathepsins, which act as proteolytic enzymes. These proteolytic enzyme gets activated at acidic pH and are found in lysosomes and are also termed as cysteine proteases. These proteases belong to papain family and have their elucidated role in musculoskeletal disorders. Numerous cathepsins have their targeted role in rheumatoid arthritis. These proteases are secreted through various cell types which includes matrix metalloproteases and papain like cysteine proteases. These proteases can potentially lead to bone and cartilage destruction which causes an immune response in case of inflammatory arthritis.

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“…Evaluate risk factors for serious adverse events due to MTX, such as alcohol intake, age over 70 years, and acute or chronic infections [ 299 ]. Avoid starting the drug in these patients [ 299 ].…”

Section: Methotrexate (Mtx)mentioning

confidence: 99%

Synthetic Pharmacotherapy for Systemic Lupus Erythematosus: Potential Mechanisms of Action, Efficacy, and Safety

et al. 2022

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The pharmacological treatment of systemic lupus erythematosus (SLE) aims to decrease disease activity, progression, systemic compromise, and mortality. Among the pharmacological alternatives, there are chemically synthesized drugs whose efficacy has been evaluated, but which have the potential to generate adverse events that may compromise adherence and response to treatment. Therapy selection and monitoring will depend on patient characteristics and the safety profile of each drug. The aim of this review is to provide a comprehensive understanding of the most important synthetic drugs used in the treatment of SLE, including the current treatment options (mycophenolate mofetil, azathioprine, and cyclophosphamide), review their mechanism of action, efficacy, safety, and, most importantly, provide monitoring parameters that should be considered while the patient is receiving the pharmacotherapy.

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Systematic review of recommendations on the use of methotrexate in rheumatoid arthritis

Cited by 12 publications

References 23 publications

Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Exploring the role of cathepsin in rheumatoid arthritis

Synthetic Pharmacotherapy for Systemic Lupus Erythematosus: Potential Mechanisms of Action, Efficacy, and Safety

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