EFFECTIVENESS AND SIDE EFFECTS OF USING METHOTREXATE AND ADALIMUMAB IN THE TREATMENT OF RHEUMATOID ARTHRITIS PATIENTS
Keywords:Rheumatoid Arthritis, Methotrexate, Adalimumab, Monotherapy, Combination Therapy
Rheumatoid arthritis (RA) is one of the diseases autoimmune systemic progressively characterized by inflammation of the membrane synovial that coating joints. Methotrexate (MTX) and Adalimumab are one of the drugs that are commonly used in Rheumatoid arthritis treatment. This study is aimed to look at the effectiveness and safety of both either in monotherapy and a combination of them. This study is a review of the article of experimental studies with data retrieval retrospectively on a database that has been set, namely PubMed, Google Scholar, and Portal Garuda were conducted for 6 months. The use of Adalimumab showed improvement based on the value DAS28-4(ESR) and HAQ-DI when compared with Methotrexate. The side effects caused by MTX showed the risk was more than 2% while Adalimumab. Several drug carriers are determinants of therapeutic efficacy such as sRNA (small interfering-RNA), LPNP (hybrid lipid-polymers nanoparticles), FRβ (Folate-receptor β), NF-κB (nuclear factor kappa-light-chain-enhancer of activated B-cells), β-GP (β-Glycerophosphate). The use of Adalimumab monotherapy has slightly better effectiveness than Methotrexate but has more diverse side effects but less risk. The use of the combination does not have a difference significant, but the risk of side effects from both is lower than when used alone.
Cronstein BN, Aune TM. Methotrexate and its mechanisms of action in inflammatory arthritis. Nat Rev Rheumatol [Internet]. 2020;16(3):145–54. Available from: http://dx.doi.org/10.1038/s41584-020-0373-9
Smolen JS, Emery P, Fleischmann R, Van Vollenhoven RF, Pavelka K, Durez P, et al. Adjustment of therapy in rheumatoid arthritis on the basis of achievement of stable low disease activity with adalimumab plus methotrexate or methotrexate alone: The randomised controlled OPTIMA trial. Lancet. 2014;383(9914):321–32.
Pappas DA, Kremer JM, Griffith J, Reed G, Salim B, Karki C, et al. Long-Term Effectiveness of Adalimumab in Patients with Rheumatoid Arthritis: An Observational Analysis from the Corrona Rheumatoid Arthritis Registry. Rheumatol Ther. 2017;4(2):375–89.
Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: Pathological mechanisms and modern pharmacologic therapies. Bone Res [Internet]. 2018;6(1). Available from: http://dx.doi.org/10.1038/s41413-018-0016-9
Solomon DH, Schneeweiss S, Levin R, Avorn J. Relationship between COX-2 specific inhibitors and hypertension. Hypertens (Dallas, Tex 1979). 2004 Aug;44(2):140–5.
Goldstein JL, Bello AE, Spalding W, Suh S, Fort JG. Cyclooxygenase-2 specific inhibitors and upper gastrointestinal tolerability in patients with osteoarthritis receiving concomitant low dose aspirin: pooled analysis of 2 trials. J Rheumatol. 2005 Jan;32(1):111–7.
Indonesia Health Ministry. Permenkes RI No. 43. Keputusan Menteri Kesehatan Republic Indonesia Nomor Hk.01.07/Menkes/813/2019 Tentang Formularium Nasional, 2019 (2), pp. 1–13.
Guo H, Lee C, Shah M, Janga SR, Edman MC, Klinngam W, et al. A novel elastin-like polypeptide drug carrier for cyclosporine A improves tear flow in a mouse model of Sjögren’s Syndrome. J Control Release. 2018 Dec;292:183–95.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372.
Conaghan PG, Østergaard M, Bowes MA, Wu C, Fuerst T, Van Der Heijde D, et al. Comparing the effects of tofacitinib, methotrexate and the combination, on bone marrow oedema, synovitis and bone erosion in methotrexate-naive, early active rheumatoid arthritis: Results of an exploratory randomised MRI study incorporating semiquantitati. Ann Rheum Dis. 2016;75(6):1024–33.
Keystone EC, Breedveld FC, Kupper H, Li Y, Florentinus S, Sainsbury I. Long-term use of adalimumab as monotherapy after attainment of low disease activity with adalimumab plus methotrexate in patients with rheumatoid arthritis. RMD Open. 2018;4(1).
Chen XX, Dai Q, Huang A Bin, Wu HX, Zhao DB, Li XF, et al. A multicenter, randomized, double-blind clinical trial of combination therapy with Anbainuo, a novel recombinant human TNFRII:Fc fusion protein, plus methotrexate versus methotrexate alone or Anbainuo alone in Chinese patients with moderate to severe rheu. Clin Rheumatol. 2013;32(1):99–108.
Burmester GR, Matucci-Cerinic M, Mariette X, Navarro-Blasco F, Oezer U, Kary S, et al. Safety and effectiveness of adalimumab in patients with rheumatoid arthritis during more than 5 years of therapy observed in a phase 3b and post-marketing observational study. Arthritis Rheum. 2011;63(10):S865–6.
Furst DE, Schiff MH, Fleischmann ROYM, Strand V, Charles A, Compagnone D, et al. Adalimumab , Sepenuhnya Manusia Anti – Tumor Necrosis Factor-α Antibodi Monoklonal , dan Penyerta Standar Antirematik Terapi untuk Pengobatan Rheumatoid Arthritis : Hasil dari BINTANG ( Keselamatan Percobaan Adalimumab dalam Rheumatoid Arthritis ). 2003;20.
Fleischmann R, Mysler E, Hall S, Kivitz AJ, Moots RJ, Luo Z, et al. Efficacy and safety of tofacitinib monotherapy, tofacitinib with methotrexate, and adalimumab with methotrexate in patients with rheumatoid arthritis (ORAL Strategy): a phase 3b/4, double-blind, head-to-head, randomised controlled trial. Lancet. 2017;390(10093):457–68.
Scheinfeld N. Adalimumab: A review of side effects. Expert Opin Drug Saf. 2005;4(4):637–41.
Emery P, Breedveld FC, Hall S, Durez P, Chang DJ, Robertson D, et al. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet. 2008;372(9636):375–82.
Duan W, Li H. Combination of NF-kB targeted siRNA and methotrexate in a hybrid nanocarrier towards the effective treatment in rheumatoid arthritis. J Nanobiotechnology. 2018;16.
Zhao J, Zhao M, Yu C, Zhang X, Liu J, Cheng X, et al. Multifunctional folate receptor-targeting and pH-responsive nanocarriers loaded with methotrexate for treatment of rheumatoid arthritis. Int J Nanomedicine. 2017;12:6735–46.
Chen Z, Yang M, Wang Q, Bai J, McAlinden C, Skiadaresi E, et al. Hydrogel eye drops as a non-invasive drug carrier for topical enhanced Adalimumab permeation and highly efficient uveitis treatment. Carbohydr Polym [Internet]. 2021;253(October 2020):117216. Available from: https://doi.org/10.1016/j.carbpol.2020.117216
Ahuja NK, Rajawat JS. Novel nano therapeutic materials for the effective treatment of rheumatoid arthritis-recent insights. Int J Appl Pharm. 2021;13(6):31–40.
Premkumar B. Genetic polymorphisms influencing efficacy and safety of methotrexate in rheumatoid arthritis. Asian J Pharm Clin Res. 2018;11(8):395–401.
Kashefi S, Lee SMIN, Mallaysamy S, P GT. Demographic , Clinical Characteristics And Drug Prescription Pattern In Patients With Rheumatoid Arthritis In South Indian Tertiary Care Hospital. 2016;8(8).
Gaies E, Jebabli N. Methotrexate Side Effects: Review Article. J Drug Metab Toxicol. 2012;3(4).
Das AP, Bhattacharjee S. Rheumatoid Arthritis : Molecular Basis And Cures From Nature. 2015;7(7).
Wee AISIM, Shahrir M, Mohamed BIN, Redzuan ABT. Medication Adherence Status Among Rheumatoid Arthritis Patients. 2016;8(7):3–7.
Mohammad BI, Ahmed BS, Hassan AF, Hassan SF. The Effect Of Pretreatment With Toll-Like Receptor 4 Antagonist Resatorvid On Methotrexate-Induced Liver Injury In Rats : Histopathological Study. 2018;11(12).
How to Cite
Copyright (c) 2022 ANDI MAULANA KAMRI, RIZQI NUR AZIZAH, VIRA AVISTA
This work is licensed under a Creative Commons Attribution 4.0 International License.