Risk of dose-dependent methotrexate therapy on renal functions in patients with rheumatoid arthritis

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist Pub Date : 2025-07-01 DOI:10.1016/j.ejr.2025.06.004

Dalia M. Gamal , Ghada Maged , Marwa Abdo , Reem M. Elsharabasy , Sara F. Samaan

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Abstract

Aim of the work

To study the dose-dependent effects of methotrexate (MTX) on renal functions and estimated glomerular filtration rate (eGFR) after 1 and 3 years of MTX therapy in rheumatoid arthritis (RA) patients.

Patients and methods

Medical records of 360 RA patients were reviewed. Disease activity score (DAS28) was recorded. Doses of MTX, concomitant therapies, and estimated glomerular filtration rate (eGFR) were reviewed at baseline, after 1 and 3 years of therapy.

Results

The mean age of patients was 44.6 ± 13.7 years, 80.6 % were females and disease duration was 9.9 ± 6.5 years. 36.4 % had moderate disease activity, 26.1 % high, 21.4 % low and 16.1 % in remission. There was a significant decline in eGFR after 1and 3 years of MTX therapy (p < 0.001) where at baseline it was 100.2 ± 22.6, after 1 year 91.5 ± 23.7 and after 3 years 82 ± 18.7. eGFR was similar in patients receiving MTX doses < 10 mg, 10–15 and > 15 mg/week (after 1 year p = 0.1, after 3 years p = 0.36). On regression, after 3 years, age and MTX therapy were significantly associated with decline in eGFR (p = 0.001 and p = 0.034) respectively. Seventeen patients (4.7 %) developed renal impairment (eGFR < 60 ml/min) after 1 year of MTX versus 9 (3.4 %) after 3 years. At cut off dose 18 mg/week, sensitivity 70.6 % and specificity 53.4 %, MTX could predict renal impairment after 1 year (p = 0.102) and at 15 mg/week after 3 years, sensitivity 82.4 % and specificity 36.1 % (p = 0.068).

Conclusion

Low dose MTX has a potential nephrotoxic effect, mandating close monitoring of renal functions for patients on MTX therapy.

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剂量依赖性甲氨蝶呤治疗对类风湿关节炎患者肾功能的影响

研究甲氨蝶呤（MTX）治疗1年和3年后对类风湿关节炎（RA）患者肾功能和肾小球滤过率（eGFR）的剂量依赖性影响。患者与方法回顾性分析360例RA患者的医疗记录。记录疾病活动评分（DAS28）。在治疗1年和3年后，回顾了MTX的剂量、伴随治疗和估计的肾小球滤过率（eGFR）。结果患者平均年龄为44.6±13.7岁，女性占80.6%，病程9.9±6.5年。36.4%为中度疾病活动，26.1%为高活动，21.4%为低活动，16.1%为缓解。甲氨蝶呤治疗1年和3年后eGFR显著下降(p <；0.001)，基线时为100.2±22.6,1年后为91.5±23.7,3年后为82±18.7。接受甲氨蝶呤剂量的患者eGFR相似；10毫克，10 - 15和>；15 mg/周（1年后p = 0.1, 3年后p = 0.36）。回归分析显示，3年后，年龄和MTX治疗分别与eGFR下降显著相关（p = 0.001和p = 0.034）。17例（4.7%）发生肾损害(eGFR <；60 ml/min)，而3年后为9例（3.4%）。切断剂量为18 mg/周时，MTX预测1年后肾功能损害的敏感性为70.6%，特异性为53.4% (p = 0.102)；切断剂量为15 mg/周时，MTX预测3年后肾功能损害的敏感性为82.4%，特异性为36.1% （p = 0.068）。结论低剂量MTX有潜在的肾毒性作用，应密切监测MTX治疗患者的肾功能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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