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Autoimmun Rev. 2014 Nov;13(11):1102-8. doi: 10.1016/j.autrev.2014.08.026. Epub 2014 Aug 26.

Methotrexate for the treatment of rheumatoid arthritis in the biologic era: still an "anchor" drug?

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Department of Rheumatology, Gaetano Pini Institute, Milan, Italy. Electronic address:
Department of Rheumatology, Gaetano Pini Institute, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Istituto Auxologico Italiano, Milan, Italy.


The improvement of rheumatoid arthritis (RA) management has been strictly related to methotrexate (MTX) long-term effectiveness, safety profile and its widespread use in clinical practice over the last decades. According to the results of several head-to-head comparative trials against other synthetic DMARDs, MTX has been recognised as the "anchor drug" for the treatment of RA at the end of the 1990s. The subsequent increasing knowledge in the area of RA pathophysiology has progressively expanded the arsenal of available therapeutic tools, especially by the introduction of novel drugs such as biological DMARDs. The introduction of therapies targeted to key molecules and cells involved in RA pathogenesis has significantly changed the strategies for disease management, possibly modifying the key role of MTX. This review first analyses data supporting the evolution of MTX towards the role of "anchor drug" for RA in the pre-biologic era. We will then examine how the introduction and progressive spreading of biological agents could have modified the central role of MTX in the approach to RA.

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