Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new methotrexate research articles will be listed here shortly after becoming available to us.
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Medical research on methotrexate
Rheumatology (Oxford). 2008 Jun 23;
Li EK, Griffith JF, Lee VW, Wang YX, Li TK, Lee KK, Tam LS
Objective. To examine the short-term efficacy and safety of MTX in combination with infliximab compared with infliximab and placebo in the treatment of AS using MRI to monitor its effect. Method. Thirty-eight subjects with active AS were randomized to receive MTX (MTX group) or placebo (placebo group) for 22 weeks. Both groups received infliximab for three infusions of 5 mg/kg at week 16, 18 and 22 and were followed up until week 30. MRI changes in the spine were assessed before and after infusion. Results. The Assessments in Ankylosing Spondylitis (ASAS) 20 response at week 16 was 5.4% in the MTX group vs 15.8% in the placebo group (P = 0.17). In the MTX group, 5.4, 31.6, 52.6 and 63.2% of patients vs 15.8, 21.1, 57.9 and 68.4% patients in the placebo group achieved ASAS20 at week 16, 18, 22, 30, respectively. There were no significant differences between the two groups at any time points. Likewise, the secondary outcome showed no significant differences between the two groups. MRI changes in 31 subjects showed an overall improvement of 36.4% but the changes were not significant between the two groups. Conclusions. Combination MTX with infliximab is as safe and as effective as infliximab monotherapy in the treatment of AS with a significant improvement in ASAS20 and in the different core sets in assessment. MRI improvements were also seen. However, there was no additional clinical or MRI improvement with the addition of MTX to infliximab in AS.
Metastatic Crohn's disease: a review.
J Eur Acad Dermatol Venereol. 2008 Jun 19;
Palamaras I, El-Jabbour J, Pietropaolo N, Thomson P, Mann S, Robles W, Stevens H
Metastatic Crohn's disease (MCD) indicates the presence of non-caseating granuloma of the skin at sites separated from the gastrointestinal tract by normal tissue and is the least common dermatologic manifestation of CD. In adults, MCD usually appears after the initial diagnosis of CD in 70% of cases, whereas in children, it appears at the same time as CD in almost half of the cases. The most frequent skin lesions in adults are nodules, plaques with or without ulceration on the extremities and ulcers on the genitals. In children, genital swelling with or without erythema is the most frequent presentation of MCD. Simultaneous presence of perianal CD affects more females (60%) and particularly children. Associated gastrointestinal symptoms are present in one third of the cases in adults and in half of the cases in children. Treatment is often unsatisfactory. Randomised controlled trials are lacking. Various chemotherapeutic agents have been used such as oral metronidazole, topical and/or oral steroids, azathioprine, cyclosporine, sulfasalazine, tetracyclines, topical or systemic tacrolimus, infliximab alone or with methotrexate, and surgical treatment with oral zinc sulphate. MCD represents another 'great imitator'. This reviews the most relevant characteristics of this disease, in order to increase awareness and to avoid delay in diagnosis and improve management of the whole CD complex.
Pediatric morphea (localized scleroderma): Review of 136 patients.
J Am Acad Dermatol. 2008 Jun 19;
Christen-Zaech S, Hakim MD, Afsar FS, Paller AS
BACKGROUND: Morphea is an autoimmune inflammatory sclerosing disorder that may cause permanent functional disability and disfigurement. OBJECTIVES: We sought to determine the clinical features of morphea in a large pediatric cohort. METHODS: We conducted a retrospective chart review of 136 pediatric patients with morphea from one center, 1989 to 2006. RESULTS: Most children showed linear morphea, with a disproportionately high number of Caucasian and female patients. Two patients with rapidly progressing generalized or extensive linear morphea and arthralgias developed restrictive pulmonary disease. Initial oral corticosteroid treatment and long-term methotrexate administration stabilized and/or led to disease improvement in most patients with aggressive disease. LIMITATIONS: Retrospective analysis, relatively small sample size, and risk of a selected referral population to the single site are limitations. CONCLUSIONS: These data suggest an increased prevalence of morphea in Caucasian girls, and support methotrexate as treatment for problematic forms. Visceral manifestations rarely occur; the presence of progressive problematic cutaneous disease and arthralgias should trigger closer patient monitoring.
Maxillary angiocentric EBV-associated large B cell lymphoma associated with methotrexate treatment.
J Oral Maxillofac Surg. 2008 Jul; 66(7): 1557-8
Nava VE, Sartorelli JS, Ozdemirli M
J Oral Maxillofac Surg. 2008 Jul; 66(7): 1492-5
Tanaka A, Shigematsu H, Kojima M, Sakashita H, Kusama K
J Med Toxicol. 2008 Jun; 4(2): 132-40
Smith SW, Nelson LS
A 10-year-old boy (37.5 kg; body surface area 1.26m2) with osteosarcoma of the right humerus received a planned 4-hour infusion of high-dose methotrexate (16 g, 12.7 g/m(2)). His previous medical history was notable for an implanted central venous catheter placement complicated by Horner's syndrome. Renal and hepatic functions were normal at baseline. A postinfusion methotrexate concentration was uninterpretable, but the significance of this result was not initially appreciated by the treating clinicians. Over the next 48 hours, the child developed blurry vision, painful mucositis, stomatitis, and facial blistering. Reported vital signs were: BP, 121/82 mm Hg; pulse, 111/minute; respirations, 16/minute. A physical examination was consistent with the reported symptoms. The 48-hour postinfusion serum methotrexate concentration at the time of poison control center (PCC) consultation was 171 micromol/L.
Biologic response modifier therapy for psoriatic ocular inflammatory disease.
Ocul Immunol Inflamm. 2008 May-Jun; 16(3): 89-93
Huynh N, Cervantes-Castaneda RA, Bhat P, Gallagher MJ, Foster CS
PURPOSE: To evaluate the efficacy and safety of biologic response modifiers (BRMs) in the treatment of patients with psoriatic ocular inflammatory disease. METHODS: The records of 8 patients diagnosed with psoriatic ocular inflammatory disease who received adalimumab or infliximab were reviewed. Main outcome measures were control of intraocular inflammation, visual acuities, and adverse effects of therapy. RESULTS: The mean patient age was 53 +/- 15 years. Three patients had psoriatic panuveitis, 3 had psoriatic scleritis, and 2 patients had psoriatic anterior uveitis. The ocular inflammatory disease was bilateral in 7 patients. Four patients received adalimumab, and 4 received infliximab. Average time of therapy was 6.1 +/- 4.7 months. Six patients were treated concurrently with methotrexate. With respect to visual acuity, 2 patients demonstrated improvement, 2 patients demonstrated deterioration, and 4 patients remained stable. Seven patients achieved remission of their ocular inflammation. CONCLUSIONS: BMRs can be a useful adjunctive therapy for psoriatic ocular inflammatory disease.
J Dermatolog Treat. 2008; 19(3): 146-55
Krueger GG, Gottlieb AB, Sterry W, Korman N, Van De Kerkhof P
Objective: To evaluate the safety and efficacy of multiple courses of alefacept in combination with traditional psoriasis therapy for the treatment of chronic plaque psoriasis (CPP). Methods: Patients with CPP requiring systemic therapy were eligible for this study. Patients received up to three courses of intramuscular alefacept 15 mg once weekly for 12 weeks. One concomitant psoriasis therapy (topical agents, methotrexate, cyclosporine, systemic retinoids, or ultraviolet B [UVB]) per course was allowed. The extent of disease was determined using the 7-point Physician Global Assessment (PGA; scale ranging from 0 = clear to 6 = severe). Results: More than 73% of patients improved by >/= one PGA category and >/=44% of patients improved by >/= two PGA categories across all concomitant treatments. Clinical responses tended to be greatest in patients who received alefacept plus UVB. The incidences of serious infections (
Immunol Invest. 2008; 37(4): 315-38
Dobrzanski MJ, Reome JB, Hylind JC, Rewers-Felkins KA, Abdulsamad K, Adams SL
The chemotherapeutic agent methotrexate is widely used in the treatment of breast cancer. Although its mechanism-of-action has been defined, less is known about its interaction with Ag-specific T cell-mediated antitumor responses. Type 1 CD8 T cell-mediated immune responses (Tc1) are cytolytic, produce IFN-gamma and are associated with effective antitumor responses. Using a murine transgenic TCR tumor model, we show that single-dose-treatment with methotrexate enhanced CD8-mediated type 1 antitumor responses when administered three days prior to Tc1 effector cell transfer. Co-treatment with methotrexate not only enhanced donor Tc1 cell accumulation and persistence at sites of primary tumor growth, but also promoted elevated levels of activated CD25(+) expressing donor TIL cells. This correlated with a marked decrease in the appearance of endogenous differentiated (CD44(High)) CD3/CD8/CD49b and CD3/CD4/CD49b tumor-infiltrating effector T cells at both early (Days 1-8) and late (Days 12-20) stages following treatment when compared to that of corresponding groups receiving either MTX or Tc1 cell transfer alone. Moreover, such cellular response kinetics appeared to further correlate with the down-regulation of endogenous CD4/CD44(High)/CD49b effector T cells producing IL-10 and delays in tumor growth in vivo. This suggested that Ag-specific Tc1 cell transfer, in combination with chemotherapy, can enhance antitumor responses by modulating select CD49b-expressing T effector/memory cell subpopulations involved in homeostasis and immune tolerance within the tumor environment. These studies offer insight into mechanisms that enhance T cell-based immunotherapy in cancer. Supplementary materials are available for this article. Go to the publisher's online edition of Immunological Investigations for the following free supplemental resource(s): Addendum 1.
Concurrent interstitial ectopic pregnancy and appendicitis: a case report.
J Reprod Med. 2008 May; 53(5): 378-81
Biggs RL, Magann EF, O'Boyle JD
BACKGROUND: Concurrent ectopic pregnancy and acute appendicitis is rarely encountered. Since 1960, only 22 cases have been reported. No case of concurrent interstitial ectopic pregnancy and appendicitis has ever been reported. CASE: A 24-year-old, African American woman, gravida 4, para 3, had a right interstitial ectopic pregnancy. She was managed as an inpatient with parenteral methotrexate and her beta-human chorionic gonadotropin level decreased appropriately. She was discharged 3 days after treatment but subsequently returned with right lower quadrant pain, nausea, vomiting and fever. The patient underwent laparoscopy with removal of a suppurative appendix. A stable interstitial ectopic pregnancy was visualized and left in situ. CONCLUSION: The discipline to consider concomitant abdominal pathology is paramount. The perceived rarity of an ectopic pregnancy and appendicitis should not obscure a thorough clinical evaluation.