Higher Risk of Serious Adverse Events with Methotrexate in Older CKD Patients

핵심 개념

Low-dose methotrexate in older adults with chronic kidney disease (CKD) is associated with a higher risk of serious adverse events compared to hydroxychloroquine.

초록

In a retrospective cohort study in Ontario, Canada, researchers found that starting treatment with low-dose methotrexate in older adults with CKD led to a significantly increased risk of serious adverse events requiring hospital visits compared to hydroxychloroquine. Here are the key points:

Study Design: Retrospective cohort study in Ontario, Canada.
Participants: Adults aged 66 years and older with CKD not on dialysis.
Medications: Methotrexate (5–35 mg/wk) vs. hydroxychloroquine (200-400 mg/d).
Outcomes: Risk of hospital visits for serious adverse events at 90 days.
Results: Methotrexate patients had a higher risk of adverse events compared to hydroxychloroquine patients.
Risk Factors: Patients with eGFR levels less than 45 mL/min/1.73 m2 had a higher risk.
Recommendations: Active surveillance is crucial for patients starting low-dose methotrexate.

통계

Overall, 3.55% of methotrexate patients and 1.73% of hydroxychloroquine patients experienced serious adverse events at 90 days.
Patients with eGFR levels less than 45 mL/min/1.73 m2 had a risk ratio of 2.79 for serious adverse events.

인용구

"Patients with CKD starting low-dose methotrexate should have active surveillance, including blood tests and chest radiographs performed regularly to monitor for signs of myelosuppression, infection, hepatotoxic effects, and pneumotoxic effects." - Researchers

핵심 통찰 요약

Methotrexate Carries Higher Risk for Older CKD Patients

by Heidi Splete 게시일 www.medscape.com 11-27-2023

https://www.medscape.com/viewarticle/998801

더 깊은 질문

How can healthcare providers balance the benefits of methotrexate with the increased risk of adverse events in older CKD patients?

Healthcare providers can balance the benefits of methotrexate with the increased risk of adverse events in older CKD patients by closely monitoring patients who are prescribed this medication. Regular blood tests and chest radiographs can help detect early signs of myelosuppression, infection, hepatotoxic effects, and pneumotoxic effects. Additionally, healthcare providers should consider starting patients on lower doses of methotrexate and gradually increasing the dosage based on individual tolerance levels. It is essential to educate patients about the potential risks associated with methotrexate and the importance of reporting any concerning symptoms promptly.

What alternative treatment options could be considered for older CKD patients to minimize the risk of serious adverse events?

For older CKD patients who are at a higher risk of serious adverse events with methotrexate, alternative treatment options can be considered. One option is to explore non-pharmacological interventions such as physical therapy, occupational therapy, or lifestyle modifications to manage symptoms and improve quality of life. In terms of pharmacological alternatives, healthcare providers may consider prescribing hydroxychloroquine or other disease-modifying antirheumatic drugs (DMARDs) that have a lower risk profile in older adults with CKD. Individualized treatment plans should be developed based on the patient's specific condition, comorbidities, and overall health status.

How can the findings of this study impact the broader conversation around medication safety in elderly populations with chronic conditions?

The findings of this study highlight the importance of considering age, renal function, and comorbidities when prescribing medications to elderly populations with chronic conditions. Healthcare providers need to weigh the potential benefits of a medication against the risks of adverse events, especially in vulnerable populations like older adults with CKD. This study underscores the need for personalized medicine approaches that take into account individual patient characteristics to optimize treatment outcomes while minimizing harm. It also emphasizes the significance of ongoing monitoring and surveillance to ensure the safety and efficacy of medications in elderly patients with complex health needs.