Find information on thousands of medical conditions and prescription drugs.

Methotrexate

Methotrexate (abbreviated MTX; formerly known as amethopterin) is an antimetabolite drug used in treatment of cancer and autoimmune diseases. It acts by inhibiting the metabolism of folic acid. more...

Home
Diseases
Medicines
A
B
C
D
E
F
G
H
I
J
K
L
M
Macrodantin
Maprotiline
Marcaine
Marezine
Marijuana
Marinol
Marplan
Matulane
Maxair
Maxalt
Maxolon
MDMA
Measurin
Mebendazole
Mebendazole
Meclofenoxate
Medrol
Mefenamic acid
Mefloquine
Melagatran
Melarsoprol
Meloxicam
Melphalan
Memantine
Metadate
Metamfetamine
Metamizole sodium
Metandienone
Metaxalone
Metenolone
Metformin
Methadone
Methamphetamine
Methaqualone
Metharbital
Methcathinone
Methenamine
Methionine
Methocarbamol
Methohexital
Methotrexate
Methotrexate
Methoxsalen
Methylcellulose
Methyldopa
Methylergometrine
Methylin
Methylphenidate
Methylphenobarbital
Methylprednisolone
Methyltestosterone
Methysergide
Metiamide
Metoclopramide
Metohexal
Metoprolol
Metrogel
Metronidazole
Metyrapone
Mobic
Moclobemide
Modafinil
Modicon
Monopril
Montelukast
Motrin
Moxidectin
Moxifloxacin
Moxonidine
MS Contin
Mucinex
Mucomyst
Mupirocin
Mupirocin
Muse
Mycitracin
Mycostatin
Myfortic
Mykacet
Mykinac
Myleran
Mylotarg
Mysoline
Phentermine
N
O
P
Q
R
S
T
U
V
W
X
Y
Z

History

Methotrexate originated in the 1940s when Sidney Farber at Children's Hospital Boston was testing the effects of folic acid on cancer. That inspired chemists at the drug company Lederle to start looking for antimetabolites resembling folic. The result was methotrexate, which was developed in 1948. Methotrexate gained FDA approval as an oncology drug in 1953.

Uses

Methotrexate was originally used, as part of combination chemotherapy regimens, to treat many kinds of cancers. It is still the mainstay for the treatment of many neoplastic disorders including acute lymphoblastic leukemia.

More recently it has come into use as a treatment for some autoimmune diseases, including psoriasis, psoriatic arthritis, rheumatoid arthritis (see disease-modifying antirheumatic drugs), and Crohn's disease. In the case of rheumatoid arthritis, parallel use with infliximab or etanercept has been shown to markedly improve symptoms. (Klareskog, et al., 2004)

Although not licensed for this indication, methotrexate is also sometimes used (generally in combination with misoprostol) to terminate early pregnancies, particularly ectopic pregnancies.

It can be taken orally or administered by injection (intramuscular, intravenous or intrathecal). Although daily preparations are occasionally used, most patients take weekly doses, which decreases the risk of certain side-effects.

Adverse effects

Possible side effects can include anemia, neutropenia, increased risk of bruising, and nausea. A small percentage of patients develop hepatitis, while there is an increased risk of pulmonary fibrosis.

The higher doses of methotrexate often used in cancer chemotherapy can cause toxic effects to the rapidly-dividing cells of bone marrow and gastrointestinal mucosa. The resulting myelosuppression and mucositis are often prevented (termed methotrexate "rescue") by using folinic acid supplements (not to be confused with folic acid).

Methotrexate is a highly teratogenic drug and categorized in Pregnancy Category X by the FDA. Women must not take the drug during pregnancy, if there is a risk of becoming pregnant, or if they are breastfeeding. Men who are trying to get their partner pregnant must also not take the drug. To engage in any of these activities (after discontinuing the drug), women must wait until the end of a full ovulation cycle and men must wait three months.

There is a risk of a severe adverse reaction if penicillin is prescribed alongside methotrexate.

Mode of action

Methotrexate competetively and reversibly inhibits dihydrofolate reductase (DHFR), an enzyme that is part of the folate synthesis metabolic pathway. The affinity of methotrexate for DHFR is about one thousand-fold that of folate for DHFR. Dihydrofolate reductase catalyses the conversion of dihydrofolate to the active tetrahydrofolate. Folic acid is needed for the de novo synthesis of the nucleoside thymidine, required for DNA synthesis. Methotrexate, therefore, inhibits the synthesis of DNA, RNA, thymidylates, and proteins.

Read more at Wikipedia.org


[List your site here Free!]


Costs of treatment in patients with moderate to severe plaque psoriasis: economic analysis in a randomized controlled comparison of methotrexate and cyclosporine
From Journal of Drugs in Dermatology, 3/1/05

Costs of Treatment in Patients with Moderate to Severe Plaque Psoriasis: Economic Analysis in a Randomized Controlled Comparison of Methotrexate and Cyclosporine

Opmeer BC, PhD, Heydendael VMR, MD, de Borgie CAJM, PhD, et al. Arch Dermatol. 2004;140(6):685-690.

Summary

The objective of this study was to compare the costs of treatment of psoriasis with two effective systemic therapies: methotrexate and cyclosporine. The study was a prospective randomized controlled trial in which 85 patients were treated with either methotrexate or cyclosporine for 16 weeks and then followed for 36 weeks. Cost analysis was conducted considering direct medical costs (medication, visits to health care providers, and diagnostic procedures), direct non-medical costs (personal care of psoriasis and travel expenses), and indirect costs (loss of productivity due to absence from work). Clinical and functional outcomes were also measured. Cost analysis was divided between the treatment period and the follow-up period. During the treatment period, the difference in cost was $521 in favor of the methotrexate group. The most notable difference was the cost of medication, with cyclosporine costing $890 compared with $16 for methotrexate. However, methotrexate treatment resulted in more additional days of sick leave and more personal care time by patients. In addition, more patients had to discontinue methotrexate treatment resulting in an increase in cost for resource utilization (UVB phototherapy). During the follow-up period, the need for medical resources was more variable. Those in the cyclosporine group used more topical therapy and UVB phototherapy, while the methotrexate group needed more day care treatments and personal care time. The difference in cost for the follow-up period was $112 in favor of cyclosporine. Clinical efficacy was comparable in both treatment groups. After 1 year, the overall difference in costs between methotrexate and cyclosporine for 16 weeks of treatment and follow-up was $409 in favor of methotrexate.

Comment

The authors took on the daunting and important task of trying to determine the cost of treating psoriatic patients with these two systemic therapies. The integration of direct medical and non-medical costs as well as indirect costs is of extreme importance when considering cost of treatment. The study demonstrates that cost of medication is only one variable to consider as the difference in total treatment cost of the two medications was relatively small. It is unclear whether the total treatment cost reflected in this study can be applicable to our patient population as the study was conducted in Amsterdam. In addition, patient preferences regarding their disease may result in variable utilization of services, both medical and non-medical, contributing to a difference in cost for individual patients.

COPYRIGHT 2005 Journal of Drugs in Dermatology, Inc.
COPYRIGHT 2005 Gale Group

Return to Methotrexate
Home Contact Resources Exchange Links ebay