Adverse Effects of Low-Dose Methotrexate
Authors: R. Brooks Robey, Clay A. Block
Journal: Annals of Internal Medicine (2020)

Letters21 July 2020Adverse Effects of Low-Dose MethotrexateR. Brooks Robey, MD and Clay A. Block, MD, MSR. Brooks Robey, MDVeterans Affairs Medical Center and Geisel School of Medicine at Dartmouth, White River Junction, Vermont (R.B.R., C.A.B.) and Clay A. Block, MD, MSVeterans Affairs Medical Center and Geisel School of Medicine at Dartmouth, White River Junction, Vermont (R.B.R., C.A.B.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-0524 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Using data from the Cardiovascular Inflammation Reduction Trial (CIRT), Solomon and colleagues (1) showed that the use of low-dose methotrexate (LD-MTX) (defined as dosages of 15 to 20 mg/wk) in participants with cardiovascular disease who had diabetes or metabolic syndrome but not rheumatic disease or established renal dysfunction was associated with an increased incidence of adverse events (AEs). These AEs included hematologic, gastrointestinal, infectious, pulmonary, and neoplastic skin events (1–3). We commend the authors for this important addition to the literature (2). However—in marked contrast to the finding of increases in the AEs we have listed—Solomon and ...References1. Solomon DH, Glynn RJ, Karlson EW, et al. Adverse effects of low-dose methotrexate. A randomized trial. Ann Intern Med. 2020;172:369-380. [PMID: 32066146]. doi:10.7326/M19-3369 LinkGoogle Scholar2. Bykerk VP. A call to systematically monitor for adverse events in users of low-dose methotrexate therapy. Ann Intern Med. 2020;172:425-426. [PMID: 32066142]. doi:10.7326/M20-0435 LinkGoogle Scholar3. Ridker PM, Everett BM, Pradhan A, et al; CIRT Investigators. Low-dose methotrexate for the prevention of atherosclerotic events. N Engl J Med. 2019;380:752-762. [PMID: 30415610] doi:10.1056/NEJMoa1809798 CrossrefMedlineGoogle Scholar4. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guidelines for acute kidney injury. Kidney Int Suppl. 2012;2:19-36. Google Scholar5. Stevens LA, Coresh J, Feldman HI, et al. Evaluation of the Modification of Diet in Renal Disease Study equation in a large diverse population. J Am Soc Nephrol. 2007;18:2749-2757. [PMID: 17855641] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Veterans Affairs Medical Center and Geisel School of Medicine at Dartmouth, White River Junction, Vermont (R.B.R., C.A.B.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-0524. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAdverse Effects of Low-Dose Methotrexate Daniel H. Solomon , Robert J. Glynn , Elizabeth W. Karlson , Fengxin Lu , Cassandra Corrigan , Josh Colls , Chang Xu , Jean MacFadyen , Medha Barbhaiya , Nancy Berliner , Paul F. Dellaripa , Brendan M. Everett , Aruna D. Pradhan , Sarah P. Hammond , Meredith Murray , Deepak A. Rao , Susan Y. Ritter , Anna Rutherford , Jeffrey A. Sparks , Jackie Stratton , Dong H. Suh , Sara K. Tedeschi , Kathleen M.M. Vanni , Nina P. Paynter , and Paul M Ridker Adverse Effects of Low-Dose Methotrexate Daniel H. Solomon and Jeffrey A Sparks Metrics Cited byMethotrexate related cutaneous adverse drug reactions: a systematic literature reviewComparison of the anti-inflammatory effects of different polar ginsenosides on rheumatoid arthritisEffect of Low-Dose Methotrexate on eGFR and Kidney Adverse Events: A Randomized Clinical TrialTargeted Mitochondrial Fluorescence Imaging-Guided Tumor Antimetabolic Therapy with the Imprinted Polymer Nanomedicine Capable of Specifically Recognizing Dihydrofolate Reductase 21 July 2020Volume 173, Issue 2Page: 166-167KeywordsAcute renal failureCardiovascular diseasesEstimated glomerular filtration rateInflammationMetabolic syndromeMethotrexatePulmonary diseasesRenal diseasesSkin infectionsStatistical data ePublished: 21 July 2020 Issue Published: 21 July 2020 PDF downloadLoading ...