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MTX use in the treatment of RA-associated-interstitial lung disease: a systematic review
Ines Mahmoud1,2, Fatma Majdoub2,3, Selma Bouden1,2
1Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia.
Objectives:
To assess the progression of the interstitial lung disease related to RA (RA-ILD) with MTX exposure and to evaluate the lung involvement in RA non-ILD patients with MTX exposure.
Methods:
A systematic review was performed including studies of RA patients reporting the effect of MTX on ILD, as a primary or secondary end point.
Results:
Sixteen studies were included in the systematic review. The total number of patients was 36 444, of which 18 548 (50.8%) were declared on MTX. Patients on MTX were classified into two groups, based on whether they were experiencing ILD. Comparison with control groups was performed to assess the development and/or the progression of ILD in MTX users. Non exposed MTX subjects (N-MTX) were considered as the control group in 14 studies. To evaluate the pulmonary state, studies carried out different evaluation methods: high-resolution computed tomography (10 studies), pulmonary function tests (8 studies), arterial blood gas analysis (1 study) and survival (5 studies). MTX was not associated with a risk of developing ILD (nine studies). Five studies suggested that MTX was not associated with the progression of RA-ILD. An accelerated decline in lung function was observed with low-dose MTX (one study). Better survival was shown in MTX patients compared with the N-MTX group (one study). In one study, MTX use was significantly associated with the development of acute exacerbations.
Conclusion:
MTX appears to have no association with an increased risk of ILD and/or its progression in RA patients.
Insights
Methotrexate (MTX) does not appear to increase the risk of interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients. This systematic review found no significant association between MTX use and the development or progression of RA-ILD.
Area of Science:
- Rheumatology
- Pulmonology
- Pharmacology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- Interstitial lung disease (ILD) is a serious complication of RA.
- Methotrexate (MTX) is a common disease-modifying antirheumatic drug (DMARD) used in RA management.
Conclusions:
- Methotrexate (MTX) does not appear to increase the risk of interstitial lung disease (ILD) or its progression in rheumatoid arthritis (RA) patients.
- The overall evidence suggests a lack of association between MTX and adverse pulmonary outcomes in RA, though some studies noted specific concerns requiring further investigation.
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