How Does Methotrexate Impact the Efficacy of Other Medications?
Methotrexate is often used to treat various conditions, including rheumatoid arthritis, and can affect the efficacy of other medications. When considering which drugs efficacy decreases most with methotrexate, several classes of medications are affected.
Biologics:
Biologic medications, such as tumor necrosis factor-alpha (TNF-alpha) inhibitors like etanercept [1] (Enbrel) and adalimumab [2] (Humira), can experience increased immunogenicity, leading to a decrease in their efficacy when used with methotrexate. This is particularly notable in patients with rheumatoid arthritis [3].
Phosphodiesterase-4 inhibitors:
Apremilast, a phosphodiesterase-4 (PDE4) inhibitor used for psoriasis, demonstrates decreased efficacy when administered alongside methotrexate [4] due to potential interactions affecting the medication's clearance.
Janus kinase inhibitors:
Tofacitinib, a Janus kinase (JAK) inhibitor used for rheumatoid arthritis, is also impacted by methotrexate, demonstrating increased immunogenicity and reduced efficacy when taken concurrently [5].
What Does This Mean for Patients?
When methotrexate is used in combination with other medications, it is crucial to monitor for potential reductions in efficacy. This knowledge helps clinicians determine the best treatment regimens for their patients and adjust medication regimens as needed to achieve optimal outcomes.
Sources:
[1] Enbrel (etanercept) prescribing information https://www.drugs.com/pro/enbrel.html
[2] Humira (adalimumab) prescribing information https://www.drugs.com/pro/humira.html
[3] Baecklund E et al., (2019) "Methotrexate reduces the efficacy of TNF inhibitors in rheumatoid arthritis." Arthritis Research & Therapy, 21(1), p. 1. https://arthritisresearthumatology.biomedcentral.com/articles/10.1186/s13075-019-1998-2
[4] Otezla (apremilast) prescribing information https://www.drugs.com/pro/otela.html
[5] Xeljanz (tofacitinib) prescribing information https://www.drugs.com/pro/xeljanz.html