Treatments

Methotrexate

Methotrexate (MTX) is one of the second-line immunosuppressive agents used in the treatment of non-infectious uveitis. The medication lowers the inflammation in the body and reduces the immune system activity by decreasing the production of new cells by the immune system.

MTX is usually prescribed in the following situations:

When the dose of prednisolone to maintain the quiescence of uveitis is unacceptable because high (>7.5mg/day maintenance)
When recurrent high doses of steroids are needed for relapsing disease  
When the use of immunosuppressive therapy is needed at presentation due to severity of uveitis  
When a steroid-sparing agent is needed due to prednisolone side effects

therapy

MTX is usually taken 7.5 – 25 mg orally ONCE A WEEK or can be administered subcutaneously ONCE WEEKLY (at the same time each week). The dose is taken after food.

Folic acid 5-10mg once weekly is taken on a different day to MTX (usually after 24-48 hours of the administration of MTX).
For it to work well, the medication should be taken regularly. If a dose is missed, it can be taken the following day or the day after.

The dose should not be taken three or more days late. It is unlikely that a flare up of uveitis will occur during this time. In both cases, the next dose should be taken on the usual day of the following week.

Patients should not be discouraged if the results are not immediate, because the drug takes several weeks (up to twelve weeks) to become effective on the uveitis. A reasonably long period of therapy (2 years) is usually required as maintenance therapy in most cases. However, MTX does not help everyone who takes it and in some patients the condition might not improve.

Side effects

The use of MTX can be associated with side effects. Not everyone will develop side effects from the use of the medication and presence of side effects varies from person to person. Potential side effects include:

Gastrointestinal symptoms (abdominal pain, nausea, diarrhoea, vomiting)
Pulmonary issues (breathlessness)  
Leukopenia and thrombocytopenia (reduction in the level of certain blood cells) - patients should be warned to report immediately any infections, fever and inexplicable bruising or bleeding  
Mouth ulcers, sore throat, or sore mouth

If patients experience side effects after taking MTX, they should report them immediately to the doctor. Most side effects should improve when reducing the dosage or eventually stop the medication.

Certain medical conditions contraindicate the use of MMF, including:

Other conditions required caution in the administration of the drug. The doctor needs to be informed in case of:

Patients should inform the doctor about any medications they have been taken, due to potential risk of MTX interaction with other drugs, and about allergy to medications. Patients should not take co-trimoxazole (Septrin or Bactrim).

Pregnancy

MTX can cause potential risk to the unborn foetus.

Due to potential risk to the foetus, women who might be pregnant, are breastfeeding or looking to start a family do not have to take MTX.
Women with childbearing potential should use reliable forms of contraception during the therapy.  
For male patients taking MTX it is recommended that either the male patient or his female partner use reliable contraception during the treatment.

Viral infections and vaccinations

As MTX reduces the ability of the immune system to fight infections, patients on treatment are more likely to catch infections of the skin, mouth, stomach, intestines, lungs and urinary tract. Patients should report symptoms of infections to the doctor.

Patients should avoid live vaccines while on MTX , including yellow fever, rubella and MMR. It is safe to have the flu vaccination and Pneumovax as they are not live vaccines.

Monitoring

Patients are regularly checked while on treatment.

Before starting the therapy, an initial blood test is carried out

While on treatment, blood monitoring, including FBC, U&E and LFT is performed every 2 weeks for 6 weeks, then monthly for 3 months and then at least every 12 weeks.  

Book your appointment

Send us a message and we will get back to you.