Severe methotrexate toxicity in elderly patients under diuretics
Authors' conclusion
Patients older than 70 years with lower eGFR and being on diuretics, but also on PPIs and levetiracetam, have a significantly higher risk for MTX toxicity.
Study context
- Population
- Patients admitted to a rheumatology ward with severe low-dose methotrexate (MTX) toxicity (RA, PsA or psoriasis, GCA, myositis), all older than 70 years, and controls older than 70 years without MTX toxicity400 controls
- Participants
- 12 / 168 / 232
- Comparison
- Patients >70 years with severe low-dose MTX toxicity vs MTX-treated patients >70 years without toxicity
- MTX toxicityn = 12
- MTX without toxicityn = 168reference
- Not on MTXn = 232
- Outcome
- Presentation, course and risk factors of severe low-dose MTX toxicity
Methodological detailssingle-centre, multivariate analysis
- Single-centre
- Multivariate analysis
Main finding
As reported in the abstract
Risk factors for severe MTX toxicity
| Group | Value | Diuretics | Proton pump inhibitors (PPIs) | Levetiracetam |
|---|---|---|---|---|
| MTX toxicity | median 64 (range 32–77) mL/min x 1.73 | 6/12 | 10/12 | 2/12 |
| MTX without toxicity | median 69 (range 8 to >90) mL/min x 1.73 | 24/168 | 70/168 | 1/168 |
Value
MTX toxicitymedian 64 (range 32–77) mL/min x 1.73
MTX without toxicitymedian 69 (range 8 to >90) mL/min x 1.73
Diuretics
MTX toxicity6/12
MTX without toxicity24/168
Proton pump inhibitors (PPIs)
MTX toxicity10/12
MTX without toxicity70/168
Levetiracetam
MTX toxicity2/12
MTX without toxicity1/168
- MTX toxicity vs MTX without toxicity: P = 0.0251 — lower in MTX toxicity
Observational data: associations, not effects.
Further findings
Course of severe MTX toxicity
- Died from infections
- 1
- Survived under folinic acid administration
- 11
Renal impairment among controls
- Not on MTX had more renal impairment than MTX-treated controls
Original publication
Severe methotrexate toxicity in elderly patients under diuretics. RMD Open. Published 4 January 2024. doi:10.
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