Adverse effect profile with low-dose methotrexate therapy in patients suffering with rheumatic diseases

Vijaya Prasanna Parimi; Mehdi Ali Mirza; Rajiv Kumar Bandaru; Bhavana Surapareddy; Sudha Bala; Srigaari Rakesh

doi:10.5455/njppp.2023.13.09431202324092023

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Online Publishing Date:
13 / 10 / 2023

Natl J Physiol Pharm Pharmacol. 2024; 14(5):

doi: 10.5455/njppp.2023.13.09431202324092023

Adverse effect profile with low-dose methotrexate therapy in patients suffering with rheumatic diseases

Vijaya Prasanna Parimi, Mehdi Ali Mirza, Rajiv Kumar Bandaru, Bhavana Surapareddy, Sudha Bala, Srigaari Rakesh.

Abstract
Background: Methotrexate (MTX) is the anchor drug for the management of many systemic inflammatory diseases. High-dose MTX is associated with various toxicities which may lead to drug discontinuation or interruption of therapy. Low-dose MTX is widely used for treating various systemic autoimmune diseases and is considered relatively safe.

Aims and Objectives: In this study, we describe the clinical features and factors affecting adverse effects of low-dose MTX in a large cohort of patients with autoimmune rheumatic diseases (AIRDs) from a tertiary health center in South India.

Materials and Methods: This was a retrospective analysis wherein we aimed to characterize the clinical features seen in and factors associated with adverse effects due to low-dose MTX. We reviewed the medical records of patients who were receiving MTX for their underlying AIRD from the Department of Clinical Immunology and Rheumatology and General Medicine. Inclusion: Patients with AIRDs being treated with MTX, who suffered from adverse events. Excluded: Patients on other csDMARDs and bDMARDs. Clinical profile, indications of therapy, dose of MTX, adverse effects, and deranged laboratory parameters were noted.

Results: A total of 815 subjects using MTX were identified over a period of 6 months duration (n = 713 (87%) females). Underlying autoimmune conditions included rheumatoid arthritis (n = 675, 82.8%). The most common adverse event noted was hair loss (7.7%), followed by nausea (3.9%). Cytopenia and transaminitis were noted in 1.6% and 2.2%, respectively. Higher incidence of adverse events was seen in those without folic acid intake (81.2%; P = 0.0001).

Conclusion: Low-dose MTX, although causes mild adverse effects and has the potential to cause life-threatening adverse events like cytopenia, is usually well tolerated. Identification of toxicities early improves the outcomes of patient care. Folate supplementation ameliorates side effects.

Key words: Low-dose Methotrexate; Autoimmune Rheumatic Diseases; Adverse Effects

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How to Cite this Article

Pubmed Style

Parimi VP, Mirza MA, Bandaru RK, Surapareddy B, Bala S, Rakesh S. Adverse effect profile with low-dose methotrexate therapy in patients suffering with rheumatic diseases. Natl J Physiol Pharm Pharmacol. Online First: 13 Oct, 2023. doi:10.5455/njppp.2023.13.09431202324092023

Web Style

Parimi VP, Mirza MA, Bandaru RK, Surapareddy B, Bala S, Rakesh S. Adverse effect profile with low-dose methotrexate therapy in patients suffering with rheumatic diseases. https://www.njppp.com/?mno=166253 [Access: March 14, 2024]. doi:10.5455/njppp.2023.13.09431202324092023

AMA (American Medical Association) Style

Parimi VP, Mirza MA, Bandaru RK, Surapareddy B, Bala S, Rakesh S. Adverse effect profile with low-dose methotrexate therapy in patients suffering with rheumatic diseases. Natl J Physiol Pharm Pharmacol. Online First: 13 Oct, 2023. doi:10.5455/njppp.2023.13.09431202324092023

Vancouver/ICMJE Style

Parimi VP, Mirza MA, Bandaru RK, Surapareddy B, Bala S, Rakesh S. Adverse effect profile with low-dose methotrexate therapy in patients suffering with rheumatic diseases. Natl J Physiol Pharm Pharmacol, [cited March 14, 2024]; Online First: 13 Oct, 2023. doi:10.5455/njppp.2023.13.09431202324092023

Harvard Style

Parimi, V. P., Mirza, . M. A., Bandaru, . R. K., Surapareddy, . B., Bala, . S. & Rakesh, . S. (2024) Adverse effect profile with low-dose methotrexate therapy in patients suffering with rheumatic diseases. Natl J Physiol Pharm Pharmacol, Online First: 13 Oct, 2023. doi:10.5455/njppp.2023.13.09431202324092023

Turabian Style

Parimi, Vijaya Prasanna, Mehdi Ali Mirza, Rajiv Kumar Bandaru, Bhavana Surapareddy, Sudha Bala, and Srigaari Rakesh. 2024. Adverse effect profile with low-dose methotrexate therapy in patients suffering with rheumatic diseases. National Journal of Physiology, Pharmacy and Pharmacology, Online First: 13 Oct, 2023. doi:10.5455/njppp.2023.13.09431202324092023

Chicago Style

Parimi, Vijaya Prasanna, Mehdi Ali Mirza, Rajiv Kumar Bandaru, Bhavana Surapareddy, Sudha Bala, and Srigaari Rakesh. "Adverse effect profile with low-dose methotrexate therapy in patients suffering with rheumatic diseases." National Journal of Physiology, Pharmacy and Pharmacology Online First: 13 Oct, 2023. doi:10.5455/njppp.2023.13.09431202324092023

MLA (The Modern Language Association) Style

APA (American Psychological Association) Style

Parimi, V. P., Mirza, . M. A., Bandaru, . R. K., Surapareddy, . B., Bala, . S. & Rakesh, . S. (2024) Adverse effect profile with low-dose methotrexate therapy in patients suffering with rheumatic diseases. National Journal of Physiology, Pharmacy and Pharmacology, Online First: 13 Oct, 2023. doi:10.5455/njppp.2023.13.09431202324092023

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