{"id":5992,"date":"2018-11-18T11:36:51","date_gmt":"2018-11-18T16:36:51","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=5992"},"modified":"2018-11-20T11:01:31","modified_gmt":"2018-11-20T16:01:31","slug":"does-low-dose-methotrexate-prevent-athersclerotic-events-in-patients","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=5992","title":{"rendered":"Does Low Dose Methotrexate Prevent Athersclerotic Events in Patients?"},"content":{"rendered":"

A randomized clinical trial that was conducted by Paul M Ridker et al. and published in\u00a0NEJM<\/em><\/a> showed that there was no meaningful association between low dose methotrexate\u00a0(MTX) administration and a decrease in cardiovascular events. Additionally, MTX usage was associated with adverse effects.<\/span><\/p>\n

It has been shown in previous studies that inflammation plays a critical role in the development of atherosclerosis. Anti-inflammatory drugs like canakinumab, an interleukin -1beta inhibitor has been shown to be effective in decreasing cardiovascular death without any change in lipid profile or blood pressure, especially when it was associated with a decrease in CRP and IL-6 levels. This issues raised the question in the investigators’ minds whether other anti-inflammatory drugs that decrease CRP and IL-6 could be effective in the reduction of cardiovascular death or not.\u00a0<\/span>Endpoints were categorized as either primary endpoints (first occurrence of a major\u00a0<\/span>adverse cardiovascular event, hospitalization for unstable angina that led to urgent coronary revascularization) or secondary endpoints (death from any cause, a composite of major adverse cardiovascular events plus any coronary revascularization, hospitalization for congestive heart failure, and a composite of major adverse cardiovascular events plus coronary revascularization, hospitalization for congestive heart failure, or death from any cause).<\/span><\/p>\n

\"\"[perfectpullquote align=”full” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]“The observations in CANTOS, CIRT, and other trials highlight the importance of considering the mechanistic diversity of inflammatory pathways in atherosclerosis and of exploring approaches to their inhibition.” -Paul Ridker et al.<\/strong>[\/perfectpullquote]<\/span><\/p>\n

A randomized, double-blinded, placebo-controlled study was designed. They included 4786 patients with multivessel coronary artery disease (39% percent of participants) or myocardial infarction (61% of participants) in the study. The patients were given oral methotrexate once weekly with a sequential increase in dosage from 5 mg to 10 mg to 15 mg. Out of patients who completed the trial, the investigators randomized patients to either continue MTX 15 mg weekly (2391 patients) or continue placebo (2395 patients) for 4 months, and then continued MTX 20 mg weekly.\u00a0<\/span>The study was terminated due to futility. Results of the study after 8 months treatment showed that the MTX was associated with abnormal liver function test development and a decrease in white blood cells, hematocrit, and hemoglobin level. Also, it was shown in this study that MTX did not decrease CRP, IL-1beta, or interleukin-6 levels. The median follow-\u00a0up duration in patients was 2.3 years. There was no association between methotrexate use and any of the predefined endpoints. MTX also was associated with a higher incidence of non\u2013basal-cell skin cancers.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

A randomized clinical trial that was conducted by Paul M Ridker et al. and published in\u00a0NEJM showed that there was no meaningful association between low dose methotrexate\u00a0(MTX) administration and a decrease in cardiovascular events. Additionally, MTX usage was associated with adverse effects.<\/p>\n","protected":false},"author":219,"featured_media":6009,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,163,8,9],"tags":[47],"ppma_author":[1051],"class_list":{"0":"post-5992","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-acs","8":"category-cardio-immuno-oncology","9":"category-news","10":"category-prevention","11":"tag-featured","12":"author-mahshid"},"authors":[{"term_id":1051,"user_id":219,"is_guest":0,"slug":"mahshid","display_name":"Mahshid Mir","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/43b34884ba0eb53ed116aa56414d4ea88c4b5cc05bf1a666bdb9ed92c55bdaf3?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/5992","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/219"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5992"}],"version-history":[{"count":7,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/5992\/revisions"}],"predecessor-version":[{"id":6022,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/5992\/revisions\/6022"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/6009"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5992"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5992"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5992"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=5992"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}