ArticleSeminars in dialysis
Risk of Serious Adverse Events and Death With Low-Dose Methotrexate Versus Hydroxychloroquine in Adults Receiving Dialysis.
Article in Seminars in dialysis. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSeveral case reports have linked low-dose methotrexate to serious adverse events, including death, in dialysis patients. We compared the risk of serious adverse events in dialysis patients initiating low-dose methotrexate versus hydroxychloroquine.
methodsUsing linked healthcare databases in Ontario, Canada (1997-2020), we identified 55 new users of low-dose methotrexate and 407 new users of hydroxychloroquine. The primary outcome was the 90-day risk of death or hospitalization with myelosuppression, sepsis, pneumotoxicity, or hepatotoxicity. Adjusting for age, sex, and a proxy for polypharmacy, a modified Poisson regression was used to estimate adjusted risk ratios (aRR), and a binomial regression was used to estimate adjusted risk differences (aRD).
resultsThe median prescribed dose was 10 mg/week (IQR, 10-17.5) for methotrexate and 300 mg/day (IQR, 200-400) for hydroxychloroquine. The primary outcome occurred in 16/55 low-dose methotrexate users (29.1%) and in 29/407 hydroxychloroquine users (7.1%); aRR: 3.14 (95% CI, 1.75 to 5.63); aRD: 19.5% (95% CI, 7.5% to 31.4%). Findings were consistent across sensitivity analyses.
conclusionLow-dose methotrexate should be avoided in dialysis patients whenever possible, and alternative DMARDs should be considered.
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