CAFFEINE TO ALLEVIATE METHOTREXATE INTOLERANCE IN RHEUMATOID ARTHRITIS: A SYSTEMATIC REVIEW

Zakaria El Ouali*, Kawtar Nassar and Saadia Janani

ABSTRACT

Background: In spite of its tolerance issues, methotrexate is still considered as the cornerstone among conventional disease-modifying antirheumatic drugs in rheumatoid arthritis. Some patients report a reduction of gastrointestinal side effects when they consume caffeine concomitantly. However, some studies suggest that caffeine can reduce the efficacy of methotrexate. Objective: To break through this paradox, the aim of this study was to evaluate the effects of caffeine consumption on efficacy and tolerance of methotrexate in patients with rheumatic diseases. Methods: A systematic review was performed following the PRISMA statement to identify all published clinical studies that evaluated the effect of caffeine on the efficacy and tolerance of methotrexate in patients with rheumatic diseases. PubMed, Google Scholar, ScienceDirect, and Cochrane Library databases were investigated from January 2000 until June 2020. Results: Among 34 identified studies, 7 fulfilled our criteria for inclusion: three studies were about efficacy, and four about tolerance. Taken together, these studies tend to show that caffeine consumption does not reduce the efficacy of methotrexate, and that caffeine consumption concomitantly with the weekly dose of treatment improves its tolerance. Conclusion: Available studies to date are limited but allow to draw clinical implications for the management of methotrexate intolerance. First, caffeine doesn’t seem not reduce the efficacy of methotrexate. Second, caffeine may improve methotrexate tolerance when taken concomitantly with the medication weekly dose. The addition of 2 cups of coffee in the morning of the medication day, and another 2 cups 1-3 hours before taking the MTX may help in alleviating symptoms.

Keywords: Caffeine; Methotrexate; Efficacy; Tolerance; Rheumatoid arthritis; Adenosine.