Gupta Kushagra, Ravindran Vinod
Joint and Autoimmune Clinic, Gupta Medical Centre, Hisar, Haryana, India.
Department of Rheumatology, Centre for Rheumatology, Calicut, Kerala, India.
J R Coll Physicians Edinb. 2025 Mar;55(1):59-68. doi: 10.1177/14782715241312256. Epub 2025 Jan 10.
Low-dose methotrexate (LD-MTX) is the anchor drug used in the treatment of various rheumatological illnesses. There are a lot of misconceptions associated with the long-term use of MTX in the minds of practitioners. The origin of most of these myths stems from the ill effects associated with high-dose MTX used in cancer chemotherapy. In this review, we have summarised and discussed the latest data regarding the safety of LD-MTX. The current evidence underscores the safety of LD-MTX. It is not associated with liver and lung fibrosis as previously thought. Other major concerns such as bone marrow suppression and increased risk of infection are rare with chronic LD-MTX therapy. Hypersensitivity pneumonitis is a rare acute lung toxicity associated with MTX intake, it does not cause interstitial lung disease and in fact, may be protective against it. There is a slight concern about the increased risk of skin malignancy associated with MTX intake; however, association with no other malignancy has been found. It has taken many decades for researchers to clear the various preconceptions associated with MTX. It is time for the academic community to embrace LD-MTX as a new, separate and reinvented drug.
低剂量甲氨蝶呤（LD-MTX）是用于治疗各种风湿性疾病的主要药物。在从业者的观念中，对于长期使用甲氨蝶呤存在许多误解。这些误解大多源于癌症化疗中使用的高剂量甲氨蝶呤所带来的不良影响。在本综述中，我们总结并讨论了有关低剂量甲氨蝶呤安全性的最新数据。目前的证据强调了低剂量甲氨蝶呤的安全性。它与之前认为的肝肺纤维化无关。慢性低剂量甲氨蝶呤治疗很少出现其他主要问题，如骨髓抑制和感染风险增加。过敏性肺炎是与摄入甲氨蝶呤相关的一种罕见的急性肺毒性，它不会导致间质性肺病，事实上，可能对其有保护作用。对于摄入甲氨蝶呤会增加皮肤恶性肿瘤的风险存在一些担忧；然而，尚未发现与其他恶性肿瘤有关联。研究人员花了几十年时间才消除了与甲氨蝶呤相关的各种先入之见。现在是学术界将低剂量甲氨蝶呤视为一种新的、独立的和经过重新认识的药物的时候了。
