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Methotrexate is an immunosuppressant drug used in the treatment of cancer, arthritis and psoriasis.
It is not a first line treatment for multiple sclerosis, but research has shown that it can reduce relapse rates and slow progression in people with MS. It is not one of the standard disease modifying drugs for relapsing MS used in the UK.
Methotrexate is taken orally as tablets.
Methotrexate was well tolerated at the low doses used in the research. Longer-term use may be associated with serious side effects, including:
- lung and liver problems
- suppression of bone marrow
As a result, methotrexate is not a first line treatment for multiple sclerosis.
Research in relapsing forms of multiple sclerosis has shown methotrexate to have an effect on reducing the relapse rate and in slowing progression in the short-term. Researchers in France have explored methotrexate in combination with the steroid methylprednisolone to control aggressively relapsing MS before moving people onto one of the other disease modifying drugs.
Studies have tested methotrexate as a treatment for progressive forms of MS and found that it may have a role in slowing progression and helping with psychological symptoms in people with moderate disability.
A US study carried out in 2016 tested high-dose methotrexate on a small group of patients with central nervous system diseases. 6 out of the 12 patients who took part in the study were people with MS who had considerable disability (equal to or greater than 6.0 on the EDSS). A single dose of methotrexate was administered through the vein over two hours. The patients were then given leucovorin – a drug used with higher doses of methotrexate to help reduce potential side effects. The majority of MS patients saw improvements in their EDSS score and complete or near complete resolution of lesions within 6 months. The main side effects reported were nausea, vomiting and headaches shortly after the methotrexate had been administered. The study concluded that high-dose methotrexate with leucovorin was a ‘safe and highly effective treatment’. A larger, controlled study is being planned.