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  • Open Access

Treatment of patients with HTLV-1-associated myelopathy with methotrexate

  • 1,
  • 1,
  • 2,
  • 2,
  • 1,
  • 1,
  • 1,
  • 1, 2 and
  • 1, 2Email author
Retrovirology201411 (Suppl 1) :P33

https://doi.org/10.1186/1742-4690-11-S1-P33

  • Published:

Keywords

  • Methotrexate
  • Folic Acid
  • Haematological Toxicity
  • Acid Supplementation
  • Liver Toxicity

Introduction

The lifetime risk of developing HTLV-1 associated myelopathy (HAM) is 0.25-3%. The main pathological feature is an immune-mediated response leading to chronic inflammation of the spinal cord. The optimal long term treatment has yet to be determined although clinical improvement with ciclosporin has been shown in a pilot study. Methotrexate, commonly used for autoimmune diseases, was introduced for the treatment of HAM at the National Centre for Human Retrovirology, London, UK as an alternative to ciclosporin.

Methods

A retrospective study of patients with chronic HAM treated with methotrexate. Primary outcomes are clinical both objective and subjective using routine clinic data. Secondary outcomes virological/immunological. Methotrexate was prescribed weekly at an initial dose of 7.5mg and a maximum dose of 15mg with weekly folic acid supplementation.

Results

Duration of methotrexate 4 – 59 weeks. Generally well tolerated. Four haematological toxicities all grade 1/2 and three liver toxicities two grade 3/4 - one treatment discontinuation due to asymptomatic liver toxicity. Objective measure – Compared with baseline -57.39s (18.8-120) mean 10m timed walk improved within 4 weeks 34.54s (16.8-87), p=0.0151. The overall trend shows persistent improvement.

Subjective- Pain as measured on a Visual Analogue Scale improved over the duration of treatment with the greatest improvement occurring within the first 4 weeks of treatment. Virology and Immunological. T-cell activation markers, Th1/2 cytokine data and HTLV viral load data will be presented.

Conclusions

These preliminary data suggest that methotrexate may be beneficial for some patients with HAM and is a suitable candidate for a randomised controlled study.

Authors’ Affiliations

(1)
National Centre for Human Retrovirology, St Marys Hospital, London, UK
(2)
Section of Infectious Diseases, Imperial College, London, UK

Copyright

© Ahmed et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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