Rheumatology (Oxford, England) · 2026
MTX use in the treatment of RA-associated-interstitial lung disease: a systematic review.
Систематический обзорСтатьяНазвание и аннотация: Перевод в очереди
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Mahmoud Ines, Majdoub Fatma, Bouden Selma, Rouached Leila, Saidane Olfa, Tekaya Raoudha, Ben Tekaya Aicha, Abdelmoula Leila
Аннотация
OBJECTIVES: To assess the progression of the interstitial lung disease related to RA (RA-ILD) with MTX exposure and to evaluate the lung involvement in RA non-ILD patients with MTX exposure.
METHODS: A systematic review was performed including studies of RA patients reporting the effect of MTX on ILD, as a primary or secondary end point.
RESULTS: Sixteen studies were included in the systematic review. The total number of patients was 36 444, of which 18 548 (50.8%) were declared on MTX. Patients on MTX were classified into two groups, based on whether they were experiencing ILD. Comparison with control groups was performed to assess the development and/or the progression of ILD in MTX users. Non exposed MTX subjects (N-MTX) were considered as the control group in 14 studies. To evaluate the pulmonary state, studies carried out different evaluation methods: high-resolution computed tomography (10 studies), pulmonary function tests (8 studies), arterial blood gas analysis (1 study) and survival (5 studies). MTX was not associated with a risk of developing ILD (nine studies). Five studies suggested that MTX was not associated with the progression of RA-ILD. An accelerated decline in lung function was observed with low-dose MTX (one study). Better survival was shown in MTX patients compared with the N-MTX group (one study). In one study, MTX use was significantly associated with the development of acute exacerbations.
CONCLUSION: MTX appears to have no association with an increased risk of ILD and/or its progression in RA patients.
METHODS: A systematic review was performed including studies of RA patients reporting the effect of MTX on ILD, as a primary or secondary end point.
RESULTS: Sixteen studies were included in the systematic review. The total number of patients was 36 444, of which 18 548 (50.8%) were declared on MTX. Patients on MTX were classified into two groups, based on whether they were experiencing ILD. Comparison with control groups was performed to assess the development and/or the progression of ILD in MTX users. Non exposed MTX subjects (N-MTX) were considered as the control group in 14 studies. To evaluate the pulmonary state, studies carried out different evaluation methods: high-resolution computed tomography (10 studies), pulmonary function tests (8 studies), arterial blood gas analysis (1 study) and survival (5 studies). MTX was not associated with a risk of developing ILD (nine studies). Five studies suggested that MTX was not associated with the progression of RA-ILD. An accelerated decline in lung function was observed with low-dose MTX (one study). Better survival was shown in MTX patients compared with the N-MTX group (one study). In one study, MTX use was significantly associated with the development of acute exacerbations.
CONCLUSION: MTX appears to have no association with an increased risk of ILD and/or its progression in RA patients.