Reply: Parenteral methotrexate should be given before biological therapy

S. J. Bingham, M. H. Buch and P. Emery

Rheumatology Research Unit, Old Nurses Home, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK

Correspondence to: S. J. Bingham. E-mail: s.bingham{at}leeds.ac.uk

We thank Drs Griffin and Erkeller-Yuksel for their interest and agree with their comments recommending the use of parenteral methotrexate (MTX) to improve efficacy in RA patients. Despite increasing effective levels of drug, no increased toxicity was seen with parenteral MTX in our cohort [1]. The maintenance of patients on MTX is becoming increasingly important and strategies that increase continuation rates will lead to more effective disease control in the long term. Recent data redefine the importance of MTX as the anchor drug for a whole variety of reasons; there is now undisputed increased efficacy seen in combination with biologics, even with etanercept.

P. Emery has undertaken clinical trials and contract work for Schering-Plough and Wyeth. The other authors have declared no conflicts of interest.

References

  1. Bingham SJ et al. Parenteral methotrexate should be given before biological therapy. Rheumatology 2003;42:1009–10.[Free Full Text]
Accepted 7 November 2003





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