Evidence map›Paper›PMID 39647844›Full record

ArticleBritish journal of clinical pharmacology2025

Co-prescription of low-dose methotrexate and trimethoprim-sulfamethoxazole and the 30-day risk of death among older adults: A cohort study.

Hasti Sadeghi, Fatemeh Ahmadi, Eric McArthur, Jessica M Sontrop, Sheikh S Abdullah, Brad L Urquhart, Richard B Kim, Flory T Muanda

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of clinical pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Hasti SadeghiDepartment of Biology, Western University, London, ON, Canada.
Fatemeh AhmadiICES, Toronto, ON, Canada.
Eric McArthurICES, Toronto, ON, Canada.
Jessica M SontropDepartment of Epidemiology & Biostatistics, Western University, London, ON, Canada.
Sheikh S AbdullahICES, Toronto, ON, Canada.
Brad L UrquhartDepartment of Physiology and Pharmacology, Western University, London, Ontario, Canada.ORCID https://orcid.org/0000-0001-8324-1472
Richard B KimDepartment of Physiology and Pharmacology, Western University, London, Ontario, Canada.
Flory T MuandaICES, Toronto, ON, Canada.ORCID https://orcid.org/0000-0003-4682-6564

Funding

Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC)
6 · The paper itself

Abstract

aimsThe aim of this study was to characterize the risk of death in older adults co-prescribed low-dose methotrexate and TMP-SMX vs. low-dose methotrexate and a cephalosporin.

methodsWe conducted a retrospective, population-based, new-user cohort study in Ontario, Canada (April 1, 2002-August 1, 2022) using linked administrative healthcare data. Older adults taking low-dose methotrexate who were newly co-prescribed TMP-SMX (n = 1602) were matched 1:1 with those who were newly co-prescribed a cephalosporin. The primary outcome was death within 30 days of the antibiotic dispensing date. Secondary outcomes included all-cause hospitalization, a hospital visit with myelosuppression and a hospitalization with persistent infection defined as the main diagnosis. Propensity score matching was used to balance comparison groups on indicators of baseline health. Risk ratios (RR) were obtained using modified Poisson regression.

resultsIn a propensity-score matched cohort of 3204 adults taking low-dose methotrexate, the 30-day risk of death was similar in adults co-prescribed TMP-SMX vs. a cephalosporin (14/1602 [0.87%] vs. 15/1602 [0.94%]; RR 0.93 [95% CI 0.45-1.93]). The risk of all-cause hospitalization (RR 1.49 [95% CI 1.13-1.97]) and infection (RR 2.78 [95% CI 1.30-5.95]) was higher in adults treated with TMP-SMX than those treated with cephalosporins.

conclusionsIn older adults taking low-dose methotrexate, co-prescription of TMP-SMX vs. a cephalosporin was not associated with a higher 30-day risk of death but was associated with a higher 30-day risk of all-cause hospitalization and hospital admission with persistent infection. If verified, these risks should be balanced against the benefits of co-prescribing TMP-SMX and low-dose methotrexate.

Indexed as

Anti-Bacterial AgentsMethotrexateTrimethoprim, Sulfamethoxazole Drug CombinationAgedAged, 80 and overCephalosporinsCohort StudiesDrug Therapy, CombinationFemaleHospitalizationHumansMaleOntarioPropensity ScoreRetrospective StudiesAnti-Bacterial AgentsCephalosporinsMethotrexateTrimethoprim, Sulfamethoxazole Drug Combinationantifolatecephalosporinsdosagedrug–drug interactionlow‐dose methotrexatetoxicitytrimethoprim‐sulfamethoxazole

Identifiers

PMID39647844
PMCPMC11992661

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.