Medac: Optimizing methotrexate treatment to improve first-line therapy

Satellite Symposium
04 June 2020 08:15 - 09:45

Methotrexate is frequently used for first-line therapy in rheumatoid arthritis. The symposium will present treatment strategies and the effects of oral versus subcutaneous administration on RA clinical outcomes. The role of optimal initial dosing and route of methotrexate and its beneficial effects will be discussed.

New trends in RA combination therapy, for example Jak/Stat inhibitors, as well as adding MTX to biologic agents, and immunogenicity will be presented. Managing patients with co-morbidities like cardio-vascular diseases is a frequent challenge for rheumatologist. Therefore, this topic will be presented and discussed in detail as well. Another patient group seen in rheumatological practices are patients suffering from the heterogeneous autoimmune disease psoriatic arthritis. The various subgroups of this disease will be introduced as well as their suitability for methotrexate therapy. Clinical experience using the treat-to-target approach of therapy will be elaborated and discussed.

 Benefits of subcutaneous vs oral methotrexate in RA treatment

Worldwide, methotrexate has been established as primary disease-modifying drug in numerous rheumatic diseases, especially in rheumatoid arthritis. Moreover, it is regarded the anchor drug for combination therapies with other small molecules and the majority of biologics. This is mainly based on its reliability with respect to efficacy and the mostly mild and very well manageable side effects. The value of methotrexate is also reflected by its gold standard position in most national as well as international guidelines, including the most recent from EULAR and ACR. In addition to the originally developed oral application, it could be demonstrated in the past decade that the subcutaneous application inherits several advantages including improved bioavailability and efficacy without an altered or more severe side effect profile.

 MTX use in combination therapy

Despite methotrexate being the anchor drug in rheumatoid arthritis for many years questions remain regarding the optimal utilization of the parenteral administration. Aim was to develop recommendations for the management of methotrexate (MTX) when considering the combination with biological (b) or targeted synthetic (ts) disease modifying drugs (DMARDs) in rheumatoid arthritis (RA). Methodological procedures included nominal discussion group, systematic literature review, and Delphi survey for agreement. A panel of 11 expert rheumatologists, including two coordinators, was selected. The coordinators defined the goals, scope and users of the document and delivered a set of 11 relevant clinical questions regarding the use of MTX in combination with b or tsDMARDs, including the indication, dose, route of administration, dose-adjustments, efficacy and safety. Finally, a set of recommendations was developed that is intended to help clinicians solve usual clinical questions and facilitate decision making when treating RA patients with MTX in combination with bDMARDs or tsDMARDs. The established recommendations and their level of evidence as well as the decision process will be presented in this talk.

 Benefits of MTX in cardiovascular disease

In rheumatology practices, cardiovascular diseases (CVD) are a frequent co-morbidity in rheumatoid arthritis (RA) patients. Atherosclerosis appears to be more prevalent in RA than in general population. Growing evidence suggests that RA and atherosclerosis, which is generally recognized as an inflammatory condition, seem to be closely linked. As chronic inflammation and autoimmunity may play a key role in atherosclerosis and related cardiovascular complications in RA, suppression of systemic inflammation by DMARD can be considered to be an effective approach to reduce and prevent cardiovascular events in this patient group. For example methotrexate seems to have a beneficial effect on cardiovascular risk. In this talk, an overview on modes of action of methotrexate is given as well as hints for the daily rheumatology practice.

 Psoriatic arthritis - what rheumatologists need to know

Psoriatic arthritis (PsA) is a heterogeneous inflammatory disease with varied clinical symptoms ranging from peripheral joint disease, axial joint disease and enthesitis, to psoriasis, nail psoriasis and dactylitis. These diverse manifestations may complicate for clinicians distinguishing PsA from other forms of arthritis.

In this talk, the audience will be introduced to this heterogeneous disease by presenting and characterizing the different subgroups of PsA. Like in rheumatoid arthritis (RA), methotrexate (MTX) is a frequently used therapy due to its beneficial effects in both populations. It is registered for both indications. Despite being widely used, only limited evidence was described for its optimal application in PsA, especially in early disease. Due to the specific characteristics, not all PsA subgroups are suited for methotrexate therapy. Still, the treat-to-target approach of treatment of PsA has shown significant improvements in disease activity. The impact of rapid MTX dose escalation, a potential role of the subcutaneous route as well as the tight-control strategy of therapy will be discussed.


Title Time Add to calendar
Medac Symposium
04 June 2020 08:15 - 08:15 Add to calendar
Benefits of subcutaneous vs oral methotrexate in RA treatment
04 June 2020 08:15 - 08:38 Add to calendar
MTX use in combination therapy
04 June 2020 08:38 - 09:01 Add to calendar
Benefits of MTX in cardiovascular disease
04 June 2020 09:01 - 09:24 Add to calendar
Psoriatic arthritis - what rheumatologists need to know
04 June 2020 09:24 - 09:45 Add to calendar