Methotrexate use and risk of lung disease in psoriasis, psoriatic arthritis, and inflammatory bowel disease: systematic literature review and meta-analysis of randomised controlled trials.
Bottom Line: We compared relative risk differences using the Mantel-Haenszel random effects method to assess total respiratory adverse events, infectious respiratory adverse events, non-infectious respiratory adverse events, interstitial lung disease, and death.Findings suggested that there was no increased risk of lung disease in methotrexate treated patients with non-malignant inflammatory diseases.Given the limitations of the study, however, we cannot exclude a small but clinically important risk.
Affiliation: Department of Rheumatology, Galway University Hospitals, Galway, Republic of Ireland National University of Ireland Galway, Galway, Republic of Ireland email@example.com.Show MeSH
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Mentions: Overall, 504 respiratory adverse events were documented (table 2). Although the I2 index was low (0%), the type and number of respiratory adverse events reported varied considerably between the studies so we chose a random effects model for our analyses. Overall, methotrexate was not associated with an increased risk of total adverse respiratory events compared with comparator agents (relative risk 1.03, 95% confidence interval 0.90 to 1.17, I2=0%, fig 2). In addition we found no increased risk in infectious respiratory events (1.02, 0.88 to 1.19, I2=0%) nor non-infectious respiratory adverse events (1.07, 0.58 to 1.96, I2=0%) (see supplementary figures 1 and 2). No pulmonary deaths occurred. A single case of pneumonitis was reported in a patient treated with methotrexate in one study, but no definitive diagnostic features or additional information were reported.20
Affiliation: Department of Rheumatology, Galway University Hospitals, Galway, Republic of Ireland National University of Ireland Galway, Galway, Republic of Ireland firstname.lastname@example.org.