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May aid in identifying patients with delayed methotrexate clearance; toxicity appears to be related at least as much to the length of time that methotrexate concentrations are elevated as to the peak concentrations achieved. In patients with psoriatic arthritis, the rate of antibody development in patients receiving Humira monotherapy was comparable to patients with rheumatoid arthritis; however, in patients receiving concomitant methotrexate the rate was 7% compared to 1% in rheumatoid arthritis. Leucovorin may limit methotrexate action on normal cells by competing with methotrexate for the same transport processes into the cell. Such patients require especially careful monitoring for toxicity, and require dose reduction or, in some cases, discontinuation of methotrexate administration. MANAGEMENT: The use of methotrexate in combination with other potentially hepatotoxic agents (e. He was treated for RA with infliximab (3 mg/kg) for 3 years, as well as methotrexate (20 mg/week), and corticosteroids. In patients receiving concomitant methotrexate, the incidence was 6% compared to 26% with Humira monotherapy. Alkalinization of urine (with bicarbonate and/or acetazolamide) and intravenous hydration (1000 mL per square meter of body surface area over six hours prior to beginning the methotrexate infusion and 3000 mL per square meter of body surface area per day during the methotrexate infusion and for two days after the infusion is completed) are also important to prevent renal toxicity caused by methotrexate and/or its metabolites. No interference occurs, however, if methotrexate is measured by a radioimmunoassay (RIA). Antibodies developed in 12% of patients on adalimumab monotherapy and in 1% of patients on concurrent methotrexate.

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