Arthritis drug may work better second time around

NEW YORK (Reuters Health) - Even if an initial course of methotrexate for the treatment of rheumatoid arthritis (RA) gives disappointing results, persistence may pay off. A second course may be more successful, researchers report.

As they note in the journal Arthritis Research & Therapy, many patients continue to have active disease in spite of intensive therapy with disease-modifying antirheumatic drugs (DMARDs).

Dr. Daniel Aletaha, from the National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda, Maryland, and associates in Austria identified patients who underwent one course of DMARD that failed and then tried another type of treatment.

Among this group, 86 patients had a poor response initially to methotrexate -- either because it didn't help or because they couldn't tolerate the drug -- but then eventually tried it again.

The success rate with a second course of methotrexate was 45 percent among those for whom the drug was ineffective the first time, and success was more likely if the first course had used a low dose of methotrexate (10 milligrams per week or less).

However, patients who had side effects the first time on a low dose were likely to have adverse events when they tried it again, "suggesting that in a significant proportion of patients (about 25 percent) methotrexate is not tolerated even at very low doses."

"Reconsidering the use of methotrexate seems to be a rational approach if there was no major toxicity during a previous course of methotrexate," Aletaha's group concludes. This approach "may be valuable in patients in whom other therapies ... cannot be used or have proven insufficiently effective."

SOURCE: Arthritis Research & Therapy, February 22, 2006.