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Methotrexate chronotherapy is effective against rheumatoid arthritis.

Abstract
Methotrexate (MTX) is the most important drug for treating rheumatoid arthritis (RA). It has been stated that cytokines play an important role in the pathogenesis of RA, and that cytokine levels increase and show 24-h rhythms in RA patients. Previously, we found that arthritis was relieved after the administration of MTX at specific times in synchronization with the 24-h rhythm of tumor necrosis factor (TNF)-α in collagen-induced arthritis (CIA) animals. Based on our findings in an earlier study of the dosing time-dependent effects of MTX in MRL/lpr mice, which develop autoimmune disorders that share similarities with human RA, we examined here the utility of MTX chronotherapy in Japanese RA patients. In an initial animal modeling study, we collected blood from MRL/lpr mice at different times (2, 6, 10, 14, 18, or 22 hours after the light was turned on [HALO]), and we measured TNF-α mRNA expression in leukocytes. MTX was administered to the mice at two different dosing times (6 or 18 HALO), and various blood parameters were measured to estimate arthritis activity. TNF-α mRNA levels showed a clear 24-h rhythm with a peak at 22 HALO and a trough at 18 HALO after RA had developed. In these MRL/lpr mice, inflammation and TNF-α were markedly reduced when the MTX dosing time was matched to the time (18 HALO) when the TNF-α level began to increase. We then applied these findings to Japanese RA patients by switching them from the standard MTX three times/wk (day 1: after breakfast and supper; day 2: after breakfast schedule), to chronotherapy, in which the dose and number of doses/wk were not changed but MTX was administered once-a-day at bedtime. Disease Activity Score (DAS)28, modified health assessment questionnaire (MHAQ), and adverse effects were assessed. With MTX chronotherapy, DAS28, which is commonly used to quantitatively assess RA symptoms, was significantly improved at all follow-up clinical visit times compared with the baseline (vs. 1 mo: p = .0197, 2 mos: p = .0107, 3 mos: p = .0087). Significant symptom recovery was observed in 41.2% of patients, and 23.5% of patients achieved clinical remission during the 3 mos of follow-up. Functional capacity of RA patients, as indicated by the MHAQ, was markedly improved by chronotherapy. There were no severe adverse effects. Thus, we demonstrated (i) inflammation and plasma TNF-α concentrations were significantly reduced in MRL/lpr mice treated with MTX at 18 HALO, the time when TNF-α mRNA level began to increase; and (ii) MTX bedtime chronotherapy was safe, markedly reduced disease activity, and improved the functional capacity of RA patients. The findings on RA patients show that bedtime MTX chronotherapy can improve RA symptoms compared to the current standard dosing methods.
AuthorsHideto To, Hiromichi Yoshimatsu, Mari Tomonari, Hiroaki Ida, Toshiyuki Tsurumoto, Yasuhiro Tsuji, Emi Sonemoto, Noriko Shimasaki, Satoru Koyanagi, Hitoshi Sasaki, Ichiro Ieiri, Shun Higuchi, Atsushi Kawakami, Yukitaka Ueki, Katsumi Eguchi
JournalChronobiology international (Chronobiol Int) Vol. 28 Issue 3 Pg. 267-74 (Apr 2011) ISSN: 1525-6073 [Electronic] England
PMID21452922 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Immunoglobulin G
  • Immunosuppressive Agents
  • RNA, Messenger
  • Serum Amyloid A Protein
  • Tumor Necrosis Factor-alpha
  • Rheumatoid Factor
  • Methotrexate
Topics
  • Adult
  • Animals
  • Arthritis, Rheumatoid (drug therapy)
  • Chronotherapy
  • Circadian Rhythm
  • Drug Chronotherapy
  • Humans
  • Immunoglobulin G
  • Immunosuppressive Agents (administration & dosage, therapeutic use)
  • Leukocytes (metabolism)
  • Male
  • Methotrexate (administration & dosage, therapeutic use)
  • Mice
  • Mice, Inbred MRL lpr
  • RNA, Messenger (genetics, metabolism)
  • Rheumatoid Factor
  • Serum Amyloid A Protein (metabolism)
  • Tumor Necrosis Factor-alpha (genetics, metabolism)
  • Young Adult

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