Given the caution exercised when prescribing methotrexate to patients, with frequent blood monitoring and in some cases supervision in hospital, Minerva was interested to read that a longitudinal study of 248 patients with rheumatoid arthritis treated with methotrexate over seven years found that the drug was rarely discontinued, and not often because of blood test abnormalities (Annals of the Rheumatic Diseases 2005;64: 207-11). In this study the probability of continuing to take methotrexate over five years was 79%; 10% of all patients stopped it permanently because of adverse effects, and a third of those who stopped did so because the drug didn't offer any benefit.

Better late than never? When the United States lost half its flu vaccine supply due to problems at Chiron Corporation, the Centers for Disease Control and Prevention (CDC) told states to restrict its use to people at high risk. But late last month the CDC released 3.1 million doses of flu vaccine from an emergency stockpile and urged everyone to get a flu shot (www.cdc.gov/flu/protect/lateseasonguidance.htm). Flu vaccines are reformulated annually depending on current strains, so they go to waste unless used. The US flu season peaks in February.

Working out the best …