Side effects of methotrexate therapy for rheumatoid arthritis: A systematic review

• Published in: European journal of medicinal chemistry Vol. 158; pp. 502 - 516
• Main Authors: Wang, Wanying, Zhou, Hua, Liu, Liang
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 05.10.2018
• Subjects: Animals; Antirheumatic Agents - adverse effects; Antirheumatic Agents - pharmacokinetics; Antirheumatic Agents - pharmacology; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Disease-modifying anti-rheumatic drugs; Gastrointestinal Diseases - chemically induced; Humans; Methotrexate; Methotrexate - adverse effects; Methotrexate - pharmacokinetics; Methotrexate - pharmacology; Methotrexate - therapeutic use; Neoplasms - chemically induced; Rheumatoid arthritis; Side effects; Disease-modifying anti-rheumatic drugs; Side effects; Methotrexate; Rheumatoid arthritis
• ISSN: 0223-5234; 1768-3254
• DOI: 10.1016/j.ejmech.2018.09.027

Methotrexate (MTX) is used as an anchor disease-modifying anti-rheumatic drugs (DMARDs) in treating rheumatoid arthritis (RA) because of its potent efficacy and tolerability. MTX benefits a large number of RA patients but partially suffered from side effects. A variety of side effects can be associated with MTX when treating RA patients, from mild to severe or discontinuation of the treatment. In this report, we reviewed the possible side effects that MTX might cause from the most common gastrointestinal toxicity effects to less frequent malignant diseases. In order to achieve regimen with less side effects, the administration of MTX with appropriate dose and a careful pretreatment inspection is necessary. Further investigations are required when combining MTX with other drugs so as to enhance the efficacy and reduce side effects at the same time. The management of MTX treatment is also discussed to provide strategies for occurred side effects. Thus, this review will provide scholars with a comprehensive understanding the side effects of MTX administration by RA patients. [Display omitted] Risk factors of MTX induced side effects and their relationship. •EULAR regarded Methotrexate as the first choice conventional synthetic DMARD for RA treatment.•RA patients who accept MTX therapy have different toxic reactions.•Measures could be taken to reduce MTX induced side effects.