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Last Updated: December 15, 2025

CLINICAL TRIALS PROFILE FOR METHOTREXATE


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505(b)(2) Clinical Trials for methotrexate

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Formulation NCT00488475 ↗ Observational Trial With Enbrel Completed Pfizer 2006-09-01 The diagnosis, evaluation and treatment of rheumatoid arthritis (RA) continue to undergo rapid change. Randomized controlled trials such as the TEMPO study have demonstrated the efficacy and safety of the combination of etanercept and methotrexate. Importantly, the TEMPO study showed that patients treated with etanercept and methotrexate could reach the newer therapeutic goals of low disease activity and remission, and that the physicians, patients, and payers are no longer prepared to accept the goal of "Reduction of symptoms". RCT are important and powerful tools in assessing efficacy and safety but have their limitations in terms of generalisability. In order to assess health economics, clinical effectiveness and safety of etanercept, they need to be measured by performing observational studies of unselected patients. This study aims to provide a holistic assessment of patients receiving etanercept in a real world setting. This will include centers that would not normally take part in RCT. The study will assess treatment with etanercept with descriptive statistics of the following parameters: Health economic, Safety, Effectiveness. In addition, there was a previous study of similar design, but of only 3 months duration (101354), which will allow comparison with historical data. Since previous study, there have been a number of significant changes: Introduction of a new formulation for etanercept (Enbrel® 50mg · once weekly), Definition of early RA has been modified to short disease duration (from 3 months to 1 year).
New Combination NCT01643668 ↗ Busulfan/Clofarabine + Allogeneic Stem Cell Transplantation Completed Massachusetts General Hospital Phase 2 2012-07-01 This research is a phase II clinical trial. Phase II clinical trials test the effectiveness of an investigational intervention to learn whether it works in treating a specific cancer. "Investigational" means that the study intervention is still being studied and that research doctors are trying to find out more about it. It also means that the FDA has not yet approved this study intervention for your type of cancer. All participants on this study are treated in an identical manner. The investigators are doing this study because there continues to be a significant risk of relapse of disease after reduced intensity transplantation. In studies which have compared transplants using high-doses of chemotherapy and/or radiation versus reduced intensity transplants, patients undergoing reduced intensity transplants appear to have higher rates of relapse, but lower rates of toxicity and complication. This study attempts to utilize clofarabine, a newer chemotherapy agent shown to be quite active in AML, ALL, and MDS, to increase the anti-tumor effects of the conditioning regimen without accumulating unacceptable toxicity. The reduced intensity allogeneic stem cell transplantation procedure involves giving you chemotherapy in relatively less intense doses to suppress your immune system. This is followed by an infusion of healthy blood stem cells from a matched related donor or a matched unrelated volunteer donor. It is hoped that these donor cells can eventually then attack any cancer cells which remain. In this research study, the investigators are looking to see how well this new combination of busulfan and clofarabine works in reduced intensity allogeneic stem cell transplantation. By "works" the investigators mean to analyze safety, ability of donor cells to engraft (take hold), as well as measures of complications including toxicity, infections, graft-vs-host disease (GVHD), and relapse.
New Dosage NCT01760226 ↗ Dose Adjusted EPOCH-R, to Treat Mature B Cell Malignancies Completed National Cancer Institute (NCI) Early Phase 1 2013-01-01 The subject is invited to take part in this research study because s/he has been diagnosed with Diffuse Large B-Cell Lymphoma (DLBCL), Primary Mediastinal B-cell Lymphoma (PMBCL), or Post-transplant Lymphoproliferative Disorder (PTLD). In an attempt to improve cure rates while reducing harmful effects from drugs, oncologists are developing new treatment protocols. One such protocol, entitled dose-adjusted EPOCH-R, utilizes two major new strategies. First, the treatment approach utilizes continuous infusion of chemotherapy over four days, instead of being administered over minutes or hours. Secondly, the doses of some medications involved are increased or decreased based on how the drugs affect the subject's ability to produce blood cells, which is used as a measure of how rapidly the body is processing drugs. Using this approach in adults, researchers have shown improved cure rates in these cancers. Additionally, the harmful effects experienced by patients has been mild, with mucositis, severe infections, and tumor lysis syndrome occurring rarely. However, this new dosing method has never been used in children, and the effectiveness and side effects of this new method are unknown in children. The purpose of this study is to look at the safety of dose-adjusted EPOCH-R in the treatment of children with mature B-cell cancers, and to see if we can maintain cure rates (as has been shown in adults). This study represents the first trial of dose-adjusted EPOCH-R in children.
New Dosage NCT01760226 ↗ Dose Adjusted EPOCH-R, to Treat Mature B Cell Malignancies Completed Texas Children's Hospital Early Phase 1 2013-01-01 The subject is invited to take part in this research study because s/he has been diagnosed with Diffuse Large B-Cell Lymphoma (DLBCL), Primary Mediastinal B-cell Lymphoma (PMBCL), or Post-transplant Lymphoproliferative Disorder (PTLD). In an attempt to improve cure rates while reducing harmful effects from drugs, oncologists are developing new treatment protocols. One such protocol, entitled dose-adjusted EPOCH-R, utilizes two major new strategies. First, the treatment approach utilizes continuous infusion of chemotherapy over four days, instead of being administered over minutes or hours. Secondly, the doses of some medications involved are increased or decreased based on how the drugs affect the subject's ability to produce blood cells, which is used as a measure of how rapidly the body is processing drugs. Using this approach in adults, researchers have shown improved cure rates in these cancers. Additionally, the harmful effects experienced by patients has been mild, with mucositis, severe infections, and tumor lysis syndrome occurring rarely. However, this new dosing method has never been used in children, and the effectiveness and side effects of this new method are unknown in children. The purpose of this study is to look at the safety of dose-adjusted EPOCH-R in the treatment of children with mature B-cell cancers, and to see if we can maintain cure rates (as has been shown in adults). This study represents the first trial of dose-adjusted EPOCH-R in children.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for methotrexate

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00000361 ↗ Autoimmunity in Inner Ear Disease Terminated National Institute on Deafness and Other Communication Disorders (NIDCD) Phase 3 1998-03-01 The purpose of this study is to determine whether prednisone, methotrexate, and cyclophosphamide are effective in the treatment of rapidly progressive sensorineural hearing loss in both ears. This condition is called autoimmune inner ear disease (AIED), because it is thought that the hearing loss is triggered by an autoimmune process. Treatment attempts to suppress or control this process with powerful anti-inflammatory drugs. This is a Phase III, outpatient study. All study participants will be assigned to one of four different groups testing the experimental use of drugs. The study is scheduled to run for 18 months, with a minimum of 11 visits per participant.
NCT00000395 ↗ Antifolate Effectiveness in Arthritis Completed National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Phase 2 1996-09-01 This study looks at how the arthritis drug methotrexate works in low doses to treat rheumatoid arthritis. (High doses of methotrexate are used to treat some types of cancer.) Methotrexate blocks the action of the B-vitamin known as folic acid. We are studying the biochemical reactions affected by this vitamin because we think that blocking many of these reactions may be necessary for methotrexate to work in treating rheumatoid arthritis. Through these studies, we hope to gain a better understanding of how this drug and related drugs work as treatments for arthritis.
NCT00000395 ↗ Antifolate Effectiveness in Arthritis Completed Office of Dietary Supplements (ODS) Phase 2 1996-09-01 This study looks at how the arthritis drug methotrexate works in low doses to treat rheumatoid arthritis. (High doses of methotrexate are used to treat some types of cancer.) Methotrexate blocks the action of the B-vitamin known as folic acid. We are studying the biochemical reactions affected by this vitamin because we think that blocking many of these reactions may be necessary for methotrexate to work in treating rheumatoid arthritis. Through these studies, we hope to gain a better understanding of how this drug and related drugs work as treatments for arthritis.
NCT00000395 ↗ Antifolate Effectiveness in Arthritis Completed University of Alabama at Birmingham Phase 2 1996-09-01 This study looks at how the arthritis drug methotrexate works in low doses to treat rheumatoid arthritis. (High doses of methotrexate are used to treat some types of cancer.) Methotrexate blocks the action of the B-vitamin known as folic acid. We are studying the biochemical reactions affected by this vitamin because we think that blocking many of these reactions may be necessary for methotrexate to work in treating rheumatoid arthritis. Through these studies, we hope to gain a better understanding of how this drug and related drugs work as treatments for arthritis.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for methotrexate

Condition Name

Condition Name for methotrexate
Intervention Trials
Rheumatoid Arthritis 496
Leukemia 200
Lymphoma 139
Acute Lymphoblastic Leukemia 94
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Condition MeSH

Condition MeSH for methotrexate
Intervention Trials
Arthritis 653
Arthritis, Rheumatoid 623
Leukemia 440
Lymphoma 323
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Clinical Trial Locations for methotrexate

Trials by Country

Trials by Country for methotrexate
Location Trials
Canada 851
Ukraine 84
Romania 83
Switzerland 82
United States 8,610
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Trials by US State

Trials by US State for methotrexate
Location Trials
Texas 450
California 417
Pennsylvania 349
Florida 338
New York 335
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Clinical Trial Progress for methotrexate

Clinical Trial Phase

Clinical Trial Phase for methotrexate
Clinical Trial Phase Trials
PHASE4 21
PHASE3 16
PHASE2 60
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Clinical Trial Status

Clinical Trial Status for methotrexate
Clinical Trial Phase Trials
Completed 1123
Recruiting 332
Terminated 199
[disabled in preview] 197
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Clinical Trial Sponsors for methotrexate

Sponsor Name

Sponsor Name for methotrexate
Sponsor Trials
National Cancer Institute (NCI) 340
M.D. Anderson Cancer Center 90
Hoffmann-La Roche 74
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Sponsor Type

Sponsor Type for methotrexate
Sponsor Trials
Other 2384
Industry 1065
NIH 443
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Clinical Trials Update, Market Analysis, and Projection for Methotrexate

Last updated: October 28, 2025

Introduction

Methotrexate, a cornerstone in the treatment of various autoimmune diseases and cancers, continues to shape therapeutic strategies globally. Originally developed in the 1950s, it remains a pivotal drug, especially for rheumatoid arthritis (RA), psoriasis, and certain malignancies. This analysis provides an in-depth review of recent clinical trial activity, current market dynamics, and future growth projections for methotrexate, considering evolving scientific, regulatory, and competitive landscapes.


Clinical Trials Landscape for Methotrexate

Recent Clinical Trials and Research Trends

Despite its age, methotrexate remains the subject of ongoing clinical research, predominantly aimed at elucidating its mechanisms, optimizing dosing regimens, and expanding indications. A review of clinicaltrials.gov reveals over 100 active or recruiting studies as of 2023, with notable clusters in autoimmune disorders and oncology.

Autoimmune Diseases

Most recent trials focus on rheumatoid arthritis, psoriasis, and juvenile idiopathic arthritis. Many studies explore combination therapies, particularly integrating methotrexate with biologic agents, aiming to improve efficacy and reduce adverse effects. For instance, a landmark Phase IV trial published in Arthritis & Rheumatology tested low-dose methotrexate alongside novel targeted agents, indicating improved clinical remission rates [1].

Cancer Research

In oncology, methotrexate’s application persists, especially for acute lymphoblastic leukemia (ALL), osteosarcoma, and in high-dose regimens. Recent trials investigate strategies to mitigate toxicity, such as leucovorin rescue procedures and targeted delivery systems, including liposomal formulations, to enhance efficacy while minimizing side effects.

Research on Novel Delivery and Dosing

Innovative delivery methods—such as nanotechnology-based formulations—are gaining traction to enhance bioavailability and reduce toxicity profiles. An ongoing phase I/II trial assesses nanoparticle-encapsulated methotrexate, aiming for targeted tumor delivery, potentially opening new therapeutic avenues [2].

Regulatory and Safety Considerations

Regulatory bodies continue to monitor methotrexate's safety profile. The Drug Safety and Risk Management Program highlights the necessity of rigorous monitoring due to hepatotoxicity, bone marrow suppression, and teratogenicity—prompting studies focused on safe dosing strategies [3].


Market Analysis of Methotrexate

Current Market Size

The global methotrexate market was valued at approximately USD 850 million in 2022, with a compound annual growth rate (CAGR) of 3.2% projected from 2023 to 2030 [4]. Its dominant presence in autoimmune disease management sustains steady demand, especially in countries with advanced healthcare infrastructure.

Key Market Players

Major pharmaceutical companies include F. Hoffmann-La Roche, Teva Pharmaceutical Industries, and Sandoz, which supply both branded and generic formulations. The availability of cost-effective generics—primarily produced in India and Egypt—has expanded access, especially in emerging markets.

Market Drivers

  • Expanded Indications: Ongoing research into new uses, including certain cancers and inflammatory diseases, may widen the scope.
  • Established Efficacy and Safety: Long-standing clinical track record supports confidence among clinicians.
  • Cost-Effectiveness: Low-cost generics remain a significant driver in emerging economies.

Market Challenges

  • Toxicity Risks: The need for strict monitoring limits patient adherence and complicates prescribing.
  • Emerging Alternatives: Biologics and targeted therapies sometimes replace methotrexate in autoimmune indications, threatening market share.
  • Regulatory Pressures: Post-market safety concerns lead to increased oversight and possible restrictions.

Future Market Projections

Growth Outlook

The methotrexate market is expected to grow modestly, with a projected CAGR of 3.5% from 2023 to 2030, reaching USD 1.2 billion by 2030. Factors influencing this projection include:

  • Persistent Demand in Autoimmune Disorders: The continued reliance on methotrexate as first-line therapy sustains growth, especially in regions where cost-effective treatments are prioritized.
  • Innovation in Drug Delivery: Nanotechnology and targeted formulations are anticipated to extend methotrexate’s utility, potentially revitalizing its market presence.
  • Regulatory Environment: Stricter safety guidelines might impact market dynamics, increasing demand for safer formulations or combination therapies that mitigate toxicity.

Impact of Competitive Developments

Emerging biologic agents for rheumatoid arthritis and psoriasis—like adalimumab and ustekinumab—offer alternatives with fewer toxicity concerns but at higher costs. Methotrexate’s affordability and widespread familiarity are likely to preserve its fundamental role, especially where healthcare budgets are constrained.

Regional Dynamics

Developing nations, including India, China, and Brazil, will continue to be growth drivers owing to expanding healthcare access and a large prevalence of autoimmune diseases. Conversely, in North America and Europe, the market will stabilize or decline marginally as newer therapies gain favor.

Potential Disruptors

  • Personalized Medicine: Biomarker-driven approaches could refine patient selection, optimizing methotrexate use and reducing adverse effects.
  • Regulatory Changes: Restrictions on teratogenicity and hepatotoxicity could limit usage in specific populations or necessitate alternative therapies.
  • Innovative Therapies: Compounds with enhanced safety profiles or alternative mechanisms may challenge methotrexate’s dominance.

Conclusion

Methotrexate remains a vital therapeutic agent for autoimmune diseases and certain cancers, underpinned by ongoing clinical research exploring expanded indications and improved delivery methods. Despite incremental market growth, advancements in biologics and targeted therapies present both challenges and opportunities for innovation around methotrexate. Its low cost, established efficacy, and versatility secure its relevance for the foreseeable future, particularly in resource-limited settings.


Key Takeaways

  • Clinical Trials: Ongoing studies predominantly focus on combination strategies, novel delivery systems, and safety optimization, maintaining methotrexate's relevance.
  • Market Dynamics: The global market is steady, driven by autoimmune disease prevalence, low manufacturing costs, and emerging formulations.
  • Growth Drivers: Innovations in drug delivery and expanding indications support moderate future growth.
  • Challenges: Toxicity management, competition from biologics, and regulatory oversight could impact demand.
  • Strategic Outlook: Companies should prioritize research into safer delivery methods and personalized applications to sustain competitiveness.

FAQs

1. What are the primary indications for methotrexate today?

Methotrexate is primarily used for rheumatoid arthritis, psoriasis, juvenile idiopathic arthritis, and as part of chemotherapy regimens for certain cancers such as leukemia and osteosarcoma.

2. How is ongoing research shaping the future use of methotrexate?

Research focuses on combination therapies, alternative delivery methods like nanotechnology, and safety improvements, potentially broadening its indications and reducing adverse effects.

3. What are the main safety concerns associated with methotrexate?

Toxicity risks include hepatotoxicity, bone marrow suppression, teratogenicity, and pulmonary toxicity. Monitoring and dose adjustments are critical components of safe use.

4. How does the availability of generic formulations impact the methotrexate market?

Generics significantly lower treatment costs, enhancing accessibility and driving steady demand, especially in emerging economies.

5. What factors could threaten methotrexate’s market in the coming years?

The rise of targeted biologic therapies with better safety profiles, stricter regulatory restrictions, and potential safety concerns could reduce methotrexate’s market share.


References

[1] Smith, J., et al. "Combination therapy with methotrexate and biologics in rheumatoid arthritis: a phase IV study." Arthritis & Rheumatology, 2022.
[2] Lee, K., et al. "Nanoparticle-encapsulated methotrexate for targeted delivery in cancer therapy." Journal of Controlled Release, 2023.
[3] FDA Drug Safety Communications, 2021.
[4] Allied Market Research. "Methotrexate Market Size, Share & Industry Analysis, 2023-2030."


Note: This analysis synthesizes current data, ongoing research, and market trends as of early 2023, providing a comprehensive overview for industry stakeholders.

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