Low-dose oral methotrexate treatment in chronic progressive multiple sclerosis

We aimed to further assess the safety and efficacy of low-dose oral methotr exate (LDOM) treatment for chronic progressive MS (CPMS). We studied 20 CPM S patients, including 16 with secondary progressive MS who had shown diseas e progression in the previous year. The mean followup was 23 months. The me an EDSS score was 6.3 +/- 1.1 before treatment and 6.4 +/- 1.1 after one ye ar of treatment. At one year, 15 of 20 patients were still being treated, a nd 10 were stable. Twelve patients have completed 18 months of treatment, a nd eight are stable. Two patients stopped treatment because of side effects , two more because they did not perceive benefit, and one was lost to follo w-up. Six patients had mild, transient increases in liver enzymes not requi ring treatment interruption, and two had localized herpes zoster. Magnetic resonance imaging (MRI) performed before treatment and at one year remained unchanged in responders. We confirm that LDOM is safe in carefully selecte d and monitored CPMS patients. MTX is inexpensive and, given its anti-infla mmatory and immunomodulatory properties, may be used as add-on therapy in n on-responders to interferon beta, although hepatic toxicity may be a proble m in longterm treatment.