Abstract

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

Conway R1, Low C2, Coughlan RJ3, O'Donnell MJ4, Carey JJ5. BMJ. 2015 Mar 13;350:h1269. doi: 10.1136/bmj.h1269.
 
     
Author information

1Department of Rheumatology, Galway University Hospitals, Galway, Republic of Ireland National University of Ireland Galway, Galway, Republic of Ireland drrichardconway@gmail.com. 2Department of Rheumatology, Connolly Hospital Blanchardstown, Dublin, Republic of Ireland. 3Department of Rheumatology, Galway University Hospitals, Galway, Republic of Ireland. 4National University of Ireland Galway, Galway, Republic of Ireland. 5Department of Rheumatology, Galway University Hospitals, Galway, Republic of Ireland National University of Ireland Galway, Galway, Republic of Ireland.

Abstract

OBJECTIVE: To evaluate the relative risk of pulmonary disease among patients with psoriasis, psoriatic arthritis, and inflammatory bowel disease treated with methotrexate.

DATA SOURCES: PubMed, Cochrane central register of controlled trials, and Embase to 9 January 2014.

STUDY SELECTION: Double blind randomised controlled trials of methotrexate versus placebo or active comparator agents in adults with psoriatic arthritis, psoriasis, or inflammatory bowel disease. Studies with fewer than 50 participants or of less than 12 weeks' duration were excluded.

DATA SYNTHESIS: Two investigators independently searched both databases. All authors reviewed selected studies. 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.

RESULTS: Seven studies met our inclusion criteria, six with placebo as the comparator. Heterogeneity across the studies was not significant (I(2)=0%), allowing combination of trial results. 504 respiratory adverse events were documented in 1630 participants. Methotrexate was not associated with an increased risk of adverse respiratory events (relative risk 1.03, 95% confidence interval 0.90 to 1.17), respiratory infections (1.02, 0.88 to 1.19), or non-infectious respiratory events (1.07, 0.58 to 1.96). No pulmonary deaths occurred.

CONCLUSIONS: 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.

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