Systematic literature review investigating whether methotrexate causes chronic pulmonary fibrosis

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With regards the articles in the rejecting group, they are higher scoring on the Downs and Black score and have only low-tomoderate risk of bias.They contain cohort studies, one review article and two meta-analyses of randomised controlled trials of methotrexate.The study populations in the meta-analyses contained 1,630 and 8,584 patients.The most recent cohort study where 52/78 RA-interstitial lung disease (ILD) patients were treated with methotrexate: methotrexate treatment was actually associated with a statistically significant improved survival. ConclusionOur systematic literature review found high-quality unbiased evidence that methotrexate does not cause chronic pulmonary fibrosis in humans.In patients with RA, chronic pulmonary fibrosis is due to the underlying disease and not methotrexate.It is important to now address this across all disciplines and reject the hypothesis that methotrexate causes chronic pulmonary fibrosis as it is resulting in patients having their methotrexate therapy withdrawn without any quality evidence base to support that clinical decision.It is possible that methotrexate treatment may actually improve outcomes in RA-ILD patients which is an area for further research.6 ■

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