What is the role of methotrexate in the remission maintenance of granulomatosis with polyangiitis (GPA)?

Updated: Aug 31, 2021
  • Author: Christopher L Tracy, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Methotrexate (20-25 mg weekly, oral or subcutaneous) has been used for the maintenance of remission if the serum creatinine level is less than 1.5 mg/dL. Methotrexate has been shown to be similar to azathioprine in terms of adverse effects, efficacy in maintaining remission, and rates of relapse. [82] For example, 10-year follow-up of 97 patients with GPA who were enrolled in the WEGENT trial showed no significant difference in overall survival and relapse-free survival rates between the azathioprine and methotrexate arms. [83] The rate of relapse with methotrexate ranges from 37-58%. [84, 85, 86, 87]


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