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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Research updates re: methotrexateForum: Neurology Forum
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Re: Research updates re: methotrexatePosted by ccfNeuro MD on June 09, 1997 at 11:55:14: In Reply to: Research updates re: methotrexate posted by Barbara Ashcroft on June 02, 1997 at 12:58:15: : Can you point me to any published results on the use of methotrexate with MS since the 1994 report? Everything I find simply refers to the research results reported in 1994. I am trying to decide whether I want to take it and would like to know the latest. Thank you very much. Barbara.
= Hello, Barbara. The latest published article on methotrexate and Multiple Sclerosis (MS) that I am aware of was done at the Cleveland Clinic’s Mellen Center for Multiple Sclerosis in conjunction with University of Califronia at San Francisco. It appeared in the Annals of Neurology in January 1995 (37(1):30-40). In this study, either low-dose methotrexate (7.5mg) or placebo was given weekly for two years to patients with chronic progressive multiple sclerosis. They found that the patients who received methotrexate had significantly less progression of their impairment, especially in upper-extremity function, than did patients who took the placebo. The physicians at the Mellen Center have extended the trial, the results, though, have not yet been fully analyzed or published. The treatment options available for MS varies depending upon the type. Patients with relapsing-remitting disease (whose disease course is marked by acute worsening followed by improvement) are usually treated with interferon injections (Avonex or Betaseron) or intravenous steroids. Copolymer-1 is another type of treatment just recently approved by the FDA for relapsing-remitting MS. The treatment for chronic-progressive MS (where the disease course is slowly progressive worsening without remission) is more problematic. At the Cleveland Clinic’s Mellen Center, these patients are most often treated with immunosuppressive drugs such as methotrexate, Cytoxan or occasionally, Imuran. We usually try methotrexate first (unless the course is very rapid) and have found it be effective. There was study published in 1993 from the University of of Mississippi. which looked at methotrexate in both relapsing-remitting and progressive MS. This may be the study to which you were referring. It suggested that methotrexate was effective in relapsing-remitting type but not in the progressive stages. As stated above, most patients with relapsing-remitting course are now tried on other therapies rather than methotrexate. Good luck to you. If you would like a second opinion on treatment options for MS, you may want to consider our Mellen Center, which is one of the largest MS clinics in the country. (216- 444-8600) This information is provided for general medical education purposed only. Please consult your physician for diagnostic and treatment options of your specific medical condition.
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