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Does methotrexate cause progressive fibrotic interstitial lung disease? A systematic review
Julie K Dawson1, Edmond Quah2, Ben Earnshaw2
1Department of Rheumatology St Helens Hospital, St Helens and Knowsley Trust Hospitals, Marshalls Cross Road, St Helens, Merseyside, UK. julie.dawson@sthk.nhs.uk.
Methotrexate (MTX) does not cause fibrotic interstitial lung disease (fILD). Higher quality studies indicate MTX is not linked to fILD and may even improve outcomes in rheumatoid arthritis patients with fILD.
Area of Science:
- Rheumatology
- Pulmonology
- Clinical Pharmacology
Background:
- Methotrexate (MTX) is a common medication used in treating rheumatoid arthritis (RA).
- Concerns exist regarding a potential link between MTX use and the development of fibrotic interstitial lung disease (fILD).
- This review evaluates the existing scientific literature to clarify this association.
Approach:
- A PRISMA-compliant systematic review was conducted.
- Twenty-nine articles meeting inclusion criteria were analyzed.
- Studies were assessed for quality using the Downs and Black scale and risk of bias.
Key Points:
- Thirteen articles supporting the MTX-fILD link were of low quality with high risk of bias.
- Sixteen articles refuting the MTX-fILD link were of higher quality with lower risk of bias.
- Three studies suggest MTX may slow fILD progression in RA patients.
Conclusions:
- The current body of evidence, based on higher quality studies, does not support the claim that MTX causes fILD.
- MTX is unlikely to be a causative agent for fILD.
- MTX may offer a protective or beneficial effect on fILD progression in RA patients.
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