Methotrexate Polyglutamation in a Myasthenia Gravis Clinical Trial

Authors

  • Mamatha Pasnoor, M.D. University of Kansas Medical Center, Department of Neurology, Kansas City, KS
  • Andrew J. Heim, CCRP University of Kansas Medical Center, Department of Neurology, Kansas City, KS
  • Laura Herbelin, CCRP University of Kansas Medical Center, Department of Neurology, Kansas City, KS
  • Jeffrey Statland, M.D. University of Kansas Medical Center, Department of Neurology, Kansas City, KS
  • Mazen M. Dimachkie, M.D. University of Kansas Medical Center, Department of Neurology, Kansas City, KS
  • Mara Becker, M.D. Duke University School of Medicine, Division of Rheumatology, Durham, NC
  • Richard J. Barohn, M.D. University of Kansas Medical Center, Department of Neurology, Kansas City, KS

DOI:

https://doi.org/10.17161/kjm.v13i.14513

Keywords:

Myasthenia gravis, Methotrexate, Polyglutamate

Abstract

Introduction. Methotrexate (MTX) is an immunosuppressive and anti-inflammatory drug used to treat rheumatoid arthritis (RA) and other autoimmune conditions. MTX is transported into cells, where glutamate moieties are added and is retained as methotrexate polyglutamates (MTXPGs). In the RA literature, it has been reported that the degree of polyglutamation correlates with the anti-inflammatory effect of MTX in RA. There are no prior studies evaluating the relationship between MTXPGs and myasthenia gravis (MG) outcome measures. The objective of this study was to assess the correlation between methotrexate (MTX) polyglutamates (MTXPGs) with Myasthenia Gravis (MG) outcome measures.

Methods.xAn analysis was done of blood drawn from patients enrolled in the 12-month randomized, placebo-controlled study of MTX in MG study. Red blood cell MTXPGs were measured via ultraperformance liquid chromatography and tandem mass spectrometry. MTXPG was correlated to MG outcome measures using Spearman Correlation Coefficient. A two-group t-test was used to determine the difference in MTXPG based on clinical outcome responder definitions.

Results. Twenty-one polyglutamate samples were analyzed of subjects on MTX while eight samples were analyzed from subjects on placebo. Pentaglutamate had the strongest correlation with the MG-ADL (0.99), while tetraglutamate had the strongest correlation with the QMG (0.54). Triglutamate had the strongest correlation with MGC (0.76).

Conclusion. There were variable correlations between MTXPG1-5 and MG outcomes (rho range: 0.08 to 0.99). There are strong correlations between MTXPG and the MG-ADL, QMG, and MGC. Long chain methotrexate polyglutamates correlate better with MG outcomes.

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Published

2020-02-26

How to Cite

Pasnoor, M., Heim, A. J., Herbelin, L., Statland, J., Dimachkie, M. M., Becker, M., & Barohn, R. J. . (2020). Methotrexate Polyglutamation in a Myasthenia Gravis Clinical Trial. Kansas Journal of Medicine, 13, 10–13. https://doi.org/10.17161/kjm.v13i.14513