Abstract | OBJECTIVE: METHODS: We searched the PubMed and Cochrane databases (publication dates January 1, 1990 to February 1, 2013) for double-blind, randomized, controlled trials of methotrexate versus placebo or active comparator agents in adults with RA. Studies with <100 subjects or with a duration of <24 weeks were excluded. Two investigators independently searched both databases, and all of the investigators reviewed the selected studies. We compared differences in the RR using the Mantel-Haenszel random-effects method. RESULTS: A total of 22 studies with 8,584 participants met the inclusion criteria. Heterogeneity across studies was not significant (I(2) = 3%), allowing combination of the trial results. Methotrexate was associated with an increased risk of all adverse respiratory events (RR 1.10, 95% confidence interval [95% CI] 1.02-1.19) and respiratory infection (RR 1.11, 95% CI 1.02-1.21). Patients treated with methotrexate were not at increased risk of death due to lung disease (RR 1.53, 95% CI 0.46-5.01) or noninfectious respiratory events (RR 1.02, 95% CI 0.65-1.60). A subgroup analysis of studies in which pneumonitis was described revealed an increased risk associated with methotrexate (RR 7.81, 95% CI 1.76-34.72). CONCLUSION:
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Authors | Richard Conway, Candice Low, Robert J Coughlan, Martin J O'Donnell, John J Carey |
Journal | Arthritis & rheumatology (Hoboken, N.J.)
(Arthritis Rheumatol)
Vol. 66
Issue 4
Pg. 803-12
(Apr 2014)
ISSN: 2326-5205 [Electronic] United States |
PMID | 24757133
(Publication Type: Journal Article, Meta-Analysis)
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Copyright | Copyright © 2014 by the American College of Rheumatology. |
Chemical References |
- Antirheumatic Agents
- Methotrexate
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Topics |
- Antirheumatic Agents
(adverse effects, therapeutic use)
- Arthritis, Rheumatoid
(drug therapy)
- Humans
- Lung Diseases
(chemically induced)
- Methotrexate
(adverse effects, therapeutic use)
- Risk
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