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Measurement of Erythrocyte Methotrexate Polyglutamate Levels: Ready for Clinical Use in Rheumatoid Arthritis?

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Abstract

Methotrexate (MTX) is one of the most commonly prescribed and most effective drugs for the treatment of rheumatoid arthritis (RA). Given the partial response of many patients and the side effect profile of the drug, there is considerable interest in identifying biomarkers to guide MTX therapy in RA. Upon entering cells, MTX is polyglutamated. Measuring MTX polyglutamate (MTX PG) levels in circulating red blood cells has been proposed as an objective measure to help optimize MTX therapy in RA. Data are conflicting with regard to the clinical utility of MTX PG measurements as a predictor of the efficacy or toxicity of low-dose MTX effects in RA. Should large, randomized clinical trials of this assay show consistent, reproducible, long-term correlations between MTX PG levels and efficacy or toxicity, this test could become a prominent tool for clinicians to optimize the use of MTX in treating RA.

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Acknowledgments

This work was supported by National Institutes of Health grants 2P60 AR048095-06 (University of Alabama at Birmingham Multidisciplinary Clinical Research Center, R. P. Kimberly, principal investigator) and the MCRC Project 1 (D. K. Arnett, principal investigator).

Disclosure

Drs. Brown, Morgan, Arnett, and Bridges are investigators on a National Institutes of Health–funded study on which investigators from Cypress Bioscience have collaborated.

Dr. Bridges was paid for his attendance at a meeting of an advisory board from Cypress Bioscience. No other potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 1530 3rd Avenue South, 178 SHEL, Birmingham, AL, 35294-2182, USA

    Maria I. Danila, Laura B. Hughes, Elizabeth E. Brown, Sarah L. Morgan, Joseph E. Baggott, Donna K. Arnett & S. Louis Bridges Jr

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  1. Maria I. Danila
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  2. Laura B. Hughes
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  3. Elizabeth E. Brown
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  4. Sarah L. Morgan
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  5. Joseph E. Baggott
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  6. Donna K. Arnett
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  7. S. Louis Bridges Jr
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Correspondence to S. Louis Bridges Jr.

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Danila, M.I., Hughes, L.B., Brown, E.E. et al. Measurement of Erythrocyte Methotrexate Polyglutamate Levels: Ready for Clinical Use in Rheumatoid Arthritis?. Curr Rheumatol Rep 12, 342–347 (2010). https://doi.org/10.1007/s11926-010-0120-3

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  • DOI: https://doi.org/10.1007/s11926-010-0120-3

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