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batpere wrote:Does anyone have better info on methotrexate and its use in MS?

Methotrexate Methotrexate (Rheumatrex) is relatively mild immunosuppressant in widespread use for other inflammatory neurological conditions such as myasthenia gravis or demyelinating peripheral neuropathies. In MS, it has been reported to slow the progression of upper extremity dysfunction in patients with SPMS, although a comparable benefit on the progression of lower extremity dysfunction was not demonstrated in this study. It is generally well tolerated by patients at single weekly doses ranging from 7.5 to 20 mg orally. Some patients experience nausea, headache, or diarrhea but these side effects rarely necessitate discontinuation of treatment, particularly at the lower doses used for treating MS. Complete Blood Counts (CBCs), in addition to tests of hepatic and renal function, should be followed in all patients. Some patients will develop irreversible liver damage following prolonged treatment (>2 years) and many experts recommend a blind liver biopsy in that setting so that drug-related hepatic toxicity can be detected early. There also may be an increased long-term risk of developing non-Hodgkin’s lymphoma following therapy.

Methotrexate
Methotrexate is a synthetic immunosuppressive drug that is highly effective in the short-term against rheumatoid arthritis, an autoimmune disease. It also effectively prevents EAE, the animal model for MS.

Although a clinical trial of methotrexate in the 1970s did not show benefit to MS patients, there has been renewed interest in the drug and a recent controlled trial showed the drug had modest benefit. In this trial, 30 people with primary or secondary progressive MS who were still able to walk received weekly low-dose methotrexate. Deterioration of arm function was slowed, compared to the arm function of those receiving a placebo, but there was no difference in worsening of leg function, or in overall disability.

NHE wrote: In addition, here's a brief statement about methortrexate from the UCSF MS Center.

Methotrexate Methotrexate (Rheumatrex) is relatively mild immunosuppressant in widespread use for other inflammatory neurological conditions such as myasthenia gravis or demyelinating peripheral neuropathies. In MS, it has been reported to slow the progression of upper extremity dysfunction in patients with SPMS, although a comparable benefit on the progression of lower extremity dysfunction was not demonstrated in this study. It is generally well tolerated by patients at single weekly doses ranging from 7.5 to 20 mg orally. Some patients experience nausea, headache, or diarrhea but these side effects rarely necessitate discontinuation of treatment, particularly at the lower doses used for treating MS. Complete Blood Counts (CBCs), in addition to tests of hepatic and renal function, should be followed in all patients. Some patients will develop irreversible liver damage following prolonged treatment (>2 years) and many experts recommend a blind liver biopsy in that setting so that drug-related hepatic toxicity can be detected early. There also may be an increased long-term risk of developing non-Hodgkin’s lymphoma following therapy.

From the National MS Society:

Methotrexate
Methotrexate is a synthetic immunosuppressive drug that is highly effective in the short-term against rheumatoid arthritis, an autoimmune disease. It also effectively prevents EAE, the animal model for MS.

Although a clinical trial of methotrexate in the 1970s did not show benefit to MS patients, there has been renewed interest in the drug and a recent controlled trial showed the drug had modest benefit. In this trial, 30 people with primary or secondary progressive MS who were still able to walk received weekly low-dose methotrexate. Deterioration of arm function was slowed, compared to the arm function of those receiving a placebo, but there was no difference in worsening of leg function, or in overall disability.

NHE