Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 1530 3rd Avenue South, 178 SHEL, Birmingham, AL 35294-2182, USA.
Curr Rheumatol Rep. 2010 Oct;12(5):342-7. doi: 10.1007/s11926-010-0120-3.
Methotrexate (MTX) is one of the most commonly prescribed and most effective drugs for the treatment of rheumatoid arthritis (RA). Given the partial response of many patients and the side effect profile of the drug, there is considerable interest in identifying biomarkers to guide MTX therapy in RA. Upon entering cells, MTX is polyglutamated. Measuring MTX polyglutamate (MTX PG) levels in circulating red blood cells has been proposed as an objective measure to help optimize MTX therapy in RA. Data are conflicting with regard to the clinical utility of MTX PG measurements as a predictor of the efficacy or toxicity of low-dose MTX effects in RA. Should large, randomized clinical trials of this assay show consistent, reproducible, long-term correlations between MTX PG levels and efficacy or toxicity, this test could become a prominent tool for clinicians to optimize the use of MTX in treating RA.
甲氨蝶呤（MTX）是治疗类风湿关节炎（RA）最常用和最有效的药物之一。鉴于许多患者的部分缓解和药物的副作用特征，人们非常有兴趣确定生物标志物来指导 RA 中的 MTX 治疗。进入细胞后，MTX 会发生多聚谷氨酸化。测量循环红细胞中的 MTX 多聚谷氨酸（MTX PG）水平已被提议作为一种客观的方法来帮助优化 RA 中的 MTX 治疗。关于 MTX PG 测量作为预测低剂量 MTX 在 RA 中的疗效或毒性的指标的临床实用性，数据存在争议。如果这项检测的大型随机临床试验显示 MTX PG 水平与疗效或毒性之间存在一致、可重复、长期的相关性，那么该检测可能成为临床医生优化 MTX 治疗 RA 用途的重要工具。
