The Role of Low-Dose Oral Methotrexate in Increasing Anti-TNF Drug Levels and Reducing Immunogenicity in IBD
Concomitant immunomodulation is utilised in combination with anti-TNF therapy for IBD primarily to increase drug levels and prevent anti-drug antibody formation. Whilst thiopurines have traditionally been the immunomodulator of choice in IBD populations, there are concerns regarding the long-term sa...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/13/4382 |
| _version_ | 1797591394320121856 |
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| author | Kathryn Demase Cassandra K. Monitto Robert D. Little Miles P. Sparrow |
| author_facet | Kathryn Demase Cassandra K. Monitto Robert D. Little Miles P. Sparrow |
| author_sort | Kathryn Demase |
| collection | DOAJ |
| description | Concomitant immunomodulation is utilised in combination with anti-TNF therapy for IBD primarily to increase drug levels and prevent anti-drug antibody formation. Whilst thiopurines have traditionally been the immunomodulator of choice in IBD populations, there are concerns regarding the long-term safety of the prolonged use of these agents: particularly an association with lymphoproliferative disorders. Given this, we have explored the existing literature on the use of low-dose oral methotrexate as an alternative immunomodulator for this indication. Although there is a lack of data directly comparing the efficacies of methotrexate and thiopurines as concomitant immunomodulators, the available literature supports the use of methotrexate in improving the pharmacokinetics of anti-TNF agents. Furthermore, low-dose oral methotrexate regimens appear to have comparable efficacies to higher-dose parenteral administration and are better tolerated. We suggest that clinicians should consider the use of low-dose oral methotrexate as an alternative to thiopurines when the primary purpose of concomitant immunomodulation is to improve anti-TNF pharmacokinetics. |
| first_indexed | 2024-03-11T01:36:46Z |
| format | Article |
| id | doaj.art-0dd1e57f97354bbbae4c04dbafe96488 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T01:36:46Z |
| publishDate | 2023-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-0dd1e57f97354bbbae4c04dbafe964882023-11-18T16:53:05ZengMDPI AGJournal of Clinical Medicine2077-03832023-06-011213438210.3390/jcm12134382The Role of Low-Dose Oral Methotrexate in Increasing Anti-TNF Drug Levels and Reducing Immunogenicity in IBDKathryn Demase0Cassandra K. Monitto1Robert D. Little2Miles P. Sparrow3Department of Gastroenterology, Alfred Health and Monash University, Melbourne 3004, AustraliaDepartment of Gastroenterology, Alfred Health and Monash University, Melbourne 3004, AustraliaDepartment of Gastroenterology, Alfred Health and Monash University, Melbourne 3004, AustraliaDepartment of Gastroenterology, Alfred Health and Monash University, Melbourne 3004, AustraliaConcomitant immunomodulation is utilised in combination with anti-TNF therapy for IBD primarily to increase drug levels and prevent anti-drug antibody formation. Whilst thiopurines have traditionally been the immunomodulator of choice in IBD populations, there are concerns regarding the long-term safety of the prolonged use of these agents: particularly an association with lymphoproliferative disorders. Given this, we have explored the existing literature on the use of low-dose oral methotrexate as an alternative immunomodulator for this indication. Although there is a lack of data directly comparing the efficacies of methotrexate and thiopurines as concomitant immunomodulators, the available literature supports the use of methotrexate in improving the pharmacokinetics of anti-TNF agents. Furthermore, low-dose oral methotrexate regimens appear to have comparable efficacies to higher-dose parenteral administration and are better tolerated. We suggest that clinicians should consider the use of low-dose oral methotrexate as an alternative to thiopurines when the primary purpose of concomitant immunomodulation is to improve anti-TNF pharmacokinetics.https://www.mdpi.com/2077-0383/12/13/4382methotrexateoralinfliximabadalimumabconcomitant immunomodulatorpharmacokinetics |
| spellingShingle | Kathryn Demase Cassandra K. Monitto Robert D. Little Miles P. Sparrow The Role of Low-Dose Oral Methotrexate in Increasing Anti-TNF Drug Levels and Reducing Immunogenicity in IBD Journal of Clinical Medicine methotrexate oral infliximab adalimumab concomitant immunomodulator pharmacokinetics |
| title | The Role of Low-Dose Oral Methotrexate in Increasing Anti-TNF Drug Levels and Reducing Immunogenicity in IBD |
| title_full | The Role of Low-Dose Oral Methotrexate in Increasing Anti-TNF Drug Levels and Reducing Immunogenicity in IBD |
| title_fullStr | The Role of Low-Dose Oral Methotrexate in Increasing Anti-TNF Drug Levels and Reducing Immunogenicity in IBD |
| title_full_unstemmed | The Role of Low-Dose Oral Methotrexate in Increasing Anti-TNF Drug Levels and Reducing Immunogenicity in IBD |
| title_short | The Role of Low-Dose Oral Methotrexate in Increasing Anti-TNF Drug Levels and Reducing Immunogenicity in IBD |
| title_sort | role of low dose oral methotrexate in increasing anti tnf drug levels and reducing immunogenicity in ibd |
| topic | methotrexate oral infliximab adalimumab concomitant immunomodulator pharmacokinetics |
| url | https://www.mdpi.com/2077-0383/12/13/4382 |
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