Skip to main content

Is MTX Safe in the Elderly? (12.1.2023)

Dr. Jack Cush reviews this past week's news and journal reports from Good news is that nearly 99% of adult rheumatology positions matched! But the challenge is that 45% of pediatric fellowship programs and 39% of pediatric rheum slots were unfilled in the 2024 NRMP match.

  1. Study from British Columbia, Canada, showed between 2010 & 2020, they saw 31% more new pt rheum consults (149,902); 1st time consults for inflammatory arthritis incr 28% to 51%. While time to 1st visit decr. 35%, time to DMARD initiation was unchanged

  2. #ACR23 Abst#1629 from FORWARD registry showed RA pts (n667) with LONG COVID (15%) had worse RA pre-COVID and post-infx, and had worse COVID (more ABx & hospitalization). RA-long Covid pts had 3fold more fibromyalgia (13 vs 41%)

  3. Theres a ustekinumab biosimilar, CT-P43 - In a multinational, phase III study in 509 plaque psoriasis pts, CT-P43 was equivalent to the originator, Stelara, with week 16 PASI75 scores of 78% vs 76%, and continued efficacy out to week 40

  4. National pharmacovigilance database review (1992 to 2021) identified 2217 "Falls", most serious, most in women (61%), & 38% in 18–64 yr olds. Falls attributed to immunomodulators (17%), 24% Fxs & 1 in 7 classified as adverse drug rxns (343)

  5. UK study 336 GCA pts shows after 12 mos of tocilizumab, TCZ stopped (w mean pred 2mg/d) & GCA flares at 6, 12 & 24 mos was 21%, 35% & 49% respectively; requiring prednisolone dose increase to 20 (10-40) mg/day (34% were major relapses)

  6. Chemokine CXCL10 a potential biomarker for ILD in systemic sclerosis (SSc)? Study of 165 SSc pts (41 w/ SSc-ILD) found higher serum CXCL10 in SSc-ILD (126 vs. 78.5 pg/ml). Hi levels incr risk of ILD 2.74-fold. Most CXCL10 from inflammed lung tissues

  7. Single center obs. study 74 RA-ILD pts Rx w/ antifibrotics (40 nintedanib; 34 pirfenidone); F/U 89 wks, had signif improvement in FVC estimated decline after antifibrotics (-0.3% w/ vs -6.2% w/o). 35% died, 4 lung transplants. 55% AEs, 46% D/C Rx

  8. UKs MHRA issued a safety alert #MTX maybe associated w/ photosensitivity. Based on  Coroners death (by secondary infx) report assoc w/ photosensitivity Rxn in a MTX Rx pt. Warning is because this is not a well-known side effect

  9. MTX Toxicity in Older CKD Patients

  10. Rheum Fellowship Slots Fill Up for 2024 


If you are a health practitioner, you may to comment.

Due to the nature of these comment forums, only health practitioners are allowed to comment at this time.

The author has received compensation as an advisor or consultant on this subject