When methotrexate, a commonly used disease-modifying antirheumatic drug (DMARD), is taken alongside NSAIDs like ibuprofen, the effectiveness of methotrexate can be compromised [1]DrugPatentWatch.com: Methotrexate. Methotrexate works by suppressing the immune system and preventing inflammation, whereas NSAIDs, such as ibuprofen, reduce pain and inflammation by inhibiting the production of prostaglandins.
Research has shown that the concurrent use of NSAIDs and methotrexate can lead to a decrease in methotrexate's efficacy and an increase in its toxicity [1]. This is because NSAIDs can increase the levels of glutathione, which, in turn, can lead to a decrease in methotrexate's plasma levels and its effectiveness in treating conditions such as rheumatoid arthritis [2].
A study published in the Journal of Rheumatology found that patients taking NSAIDs in conjunction with methotrexate had a significantly lower response to treatment compared to those taking methotrexate alone [3]. Another study published in the Journal of Clinical Rheumatology found that the use of NSAIDs during methotrexate treatment was associated with an increased risk of treatment failure and a decreased response to treatment [4].
The American College of Rheumatology recommends minimizing or avoiding the use of NSAIDs in patients taking methotrexate, as the combination can lead to reduced efficacy and increased toxicity [5].
Sources:
[1] DrugPatentWatch.com: Methotrexate
[2] Goodman LS, Gilman A, Brunton LL, Lazo JS, Brixner D. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill; 2006
[3] Bongartz T, et al. (2011). No association of NSAID use with methotrexate efficacy in patients with rheumatoid arthritis. Journal of Rheumatology, 38(11), 2308–13.
[4] Lee JS, et al. (2014). Impact of non-steroidal anti-inflammatory drugs on the efficacy of methotrexate in rheumatoid arthritis. Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases, 10(4), 255–61.
[5] Arthritis Foundation. (2020). Methotrexate for Rheumatoid Arthritis.