Severe methotrexate toxicity in elderly patients under diuretics

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

Abstract

OBJECTIVES: To explore the toxicity of low-dose methotrexate (MTX), an uncommon, but life-threatening event.

METHODS: We analysed the presentation, course and risk factors of all patients admitted to the rheumatology ward with severe low-dose MTX toxicity. These patients were compared with patients without signs of relevant MTX toxicity.

RESULTS: The 12 patients admitted for MTX toxicity included 7 patients with rheumatoid arthritis, 2 with psoriatic arthritis or psoriasis, 2 patients with giant cell arteritis and 1 with myositis. 1 patient died from infections, while 11 survived under folinic acid administration. All patients suffering from severe MTX toxicity were older than 70 years and were therefore compared with 400 patients who were also older than 70 years, but without MTX toxicity. Of these 400 control patients, the group of patients not on MTX (n=232) had more renal impairment than the group of patients on MTX (n=168). Compared with the 168 MTX-treated patients without toxicity, the 12 patients with life-threatening toxic events had a lower median estimated glomerular filtration rate (eGFR) at the routine visit preceding the acute event (64 (range 32-77) vs 69 (range 8 to >90) mL/min x 1.73, p=0.0251). A multivariate analysis found that patients with toxicity were more frequently treated with diuretics (6/12 vs 24/168), proton pump inhibitors (PPIs; 10/12 vs 70/168) and levetiracetam (2/12 vs 1/168).

CONCLUSIONS: 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.

Details

Original languageEnglish
Article numbere003827
Number of pages8
JournalRMD open
Volume10
Issue number1
Publication statusPublished - 4 Jan 2024
Peer-reviewedYes

External IDs

PubMedCentral PMC10773427
Scopus 85181632850

Keywords

Keywords

  • Humans, Aged, Methotrexate/adverse effects, Diuretics/adverse effects, Levetiracetam/therapeutic use, Arthritis, Rheumatoid/drug therapy, Psoriasis

Library keywords