MTX

Methotrexate is an anchor drug in the management of rheumatoid arthritis (RA). MTX monotherapy is as effective as TNF inhibitor (TNFi) monotherapy, and can prevent joint destruction in 70% of Japanese early RA patients. Also, MTX in combination with TNFi is superior to MTX monotherapy or TNFi monotherapy. Many high quality clinical studies have proved that MTX should be added to biological agents irrespective of their mode of action in inducing remission. However, it also causes hepatotoxicity, bone marrow suppression, nausea, and so on. A question arises if the dose of MTX to maintain remission could be reduced once remission is achieved. The optimal dose and usage of methotrexate remains to clarify.