MTX associated with decreased CVD risk in patients with RA

Clinical Question:
Since patients with rheumatoid arthritis are at higher risk of developing cardiovascular disease than the general
population, does methotrexate modify this risk?

Bottom Line:
No high-quality studies exist that can definitively say that methotrexate (MTX) decreases cardiovascular disease (CVD) risk in patients with rheumatoid arthritis. Several studies have found an association, however, between MTX use and decreased risk. (LOE = 2a-)

Reference:
Westlake SL, Colebatch AN, Baird J, et al. The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology (Oxford) 2010;49(2):295-307.

Study Design:
Systematic review

Funding:
Industry

Setting:
Various (meta-analysis)

Synopsis:
These authors searched multiple databases, the reference lists of included articles, and conference proceedings for studies that evaluated the relationship between MTX and CVD in patients with rheumatoid arthritis. They also contacted authors about potential unpublished studies. They didn't restrict their search to randomized trials. Two reviewers independently determined which studies to include and assessed study quality. They found no randomized trials, 8 cohort studies, 6 case-control studies, and 4 cross-sectional studies. In other words, enough to evaluate associations and develop hypotheses, but not really enough to "prove" that MTX is the cause of the outcomes. Two cohort studies with more than 2100 patients (one with 6 years and one with 11 years of follow-up) evaluated the association between MTX and CVD mortality. In one study, MTX was associated with a reduced risk of deathfrom CVD; there was no significant association in the other. Five studies -- 3 cohort studies, 1 case-control study and 1 cross-sectional study -- evaluated all CVD events (symptoms, myocardial infarction, procedures, and so forth). All but one found an association between MTX use and a lower risk of CVD. Several studies assessed other outcomes -- myocardial infarction, congestive heart failure, lipids, hypertension, and so forth -- with no firm conclusions.

PMID: 19946022
Delivered as Daily POEM: 2010-03-12

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regards, taniafdi ^_^