Methotrexate in the Treatment of AS
8/19/2004
Unlike the majority of other medications used in treating Ankylosing Spondylitis, Methotrexate is a chemotherapy drug that is also used to treat lymphomas and leukemia, but in the case of AS, given in much lower doses via injection or taken orally. The drug is a second line therapy that is often prescribed to those patients with spondylitis who are intolerant to NSAIDs (non-steroidal anti-inflammatory drugs), or those who have little response to NSAIDs. Some doctors believe it is effective in controlling the symptoms of severe spondylitis, but Methotrexate has recently been the focus of studies regarding its actual effectiveness as well as the risk vs. reward of taking the drug.
Side effects of Methotrexate include bone marrow suppression, with lowering of the blood counts, oral ulcers, nausea, gastritis or peptic laceration and liver toxicity. Thus, it is necessary to monitor blood counts often when taking the drug. Folic acid is often prescribed to those patients who are taking Methotrexate to combat thinning hair and the ulcers that can occur. In men, sperm counts can also become lowered. For more on the side effects of Methotrexate, click here.
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With such a list of potential side effects, some might wonder if the benefits of the drug could possibly be worth the risks. The Cochrane Collaboration, an international non-profit organization that reviews healthcare interventions in order to produce and promote accurate information in the medical community, recently reviewed Methotrexate for the treatment of Ankylosing Spondylitis. By examining various clinical trials, this Cochrane Review focused on the efficacy and toxicity of Methotrexate in AS.
The review found that, "There was no statistically significant benefit of Methotrexate in the examined outcomes for AS patients." But the review also admitted, "High quality, larger sample and longer period of randomized trials…are needed to verify the uncertainty about the efficacy and toxicity of [Methotrexate] for the treatment of AS." The review can be found by clicking here.
Although the Cochrane Review did not find significant statistical benefits of Methotrexate in the treatment of AS, a recent study published in the Journal of Rheumatology entitled, "Efficacy of Methotrexate in Ankylosing Spondylitis", concluded that, "[Methotrexate] is safe and effective for patients with AS. Longer studies are needed to evaluate the permanence of its benefit." This abstract for this study can be found by clicking here.
Although the debate continues regarding Methotrexate, it seems likely that Methotrexate will play less of a role in the treatment of AS in the future, simply for the fact that newer, more effective treatments have become available. The TNF Inhibitors (Enbrel having been approved by the FDA for treating AS) have shown good results in patients with moderate to severe AS and these therapies will likely be prescribed more and more frequently in the years to come.
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