Methotrexate therapy in systemic lupus erythematosus

There are 12 non-controlled and only two controlled studies using methotrex ate (MTX) in a total of 207 SLE patients in the literature. The majority of these studies evaluated mainly cutaneous and/or articular involvement and attained good results. Two studies evaluated a small number of patients wit h lupus nephritis, achieving discordant results. Two other studies in pedia tric onset systemic lupus erythematosus (SLE) also presented conflicting re sults, it being relevant that the one with poor response had the majority o f patients with nephritis. One of the controlled trials was retrospective a nd concluded that MTX was effective in the treatment of antimalarial-resist ant lupus arthritis and that toxicity leading to discontinuation of MTX was infrequent. The other controlled study was a double-blind, randomized, pla cebo-controlled clinical trial that evaluated SLE patients with mild activi ty. The authors concluded that MTX was effective in controlling cutaneous a nd articular activity and permitted prednisone dose reduction. The side eff ects were frequent but only 10% of patients needed to discontinue the medic ation. The accumulative evidence suggests that MTX in a low weekly dose may be eff ective in SLE patients with articular and/or cutaneous involvement with no response to antimalarials and low-dose prednisone and in patients in whom w e can not reduce prednisone dose due to articular or cutaneous activity. Ca ution is required concerning the side effects.