2025 Volume 37 Issue 2 Pages 84-92
Objective:
To clarify the effect of a caution alert to rheumatologists using high-dose methotrexate（MTX）for the treatment of elderly patients with rheumatoid arthritis（RA）.
Patients and methods:
The Department of Pharmacy issued a caution alert to rheumatologists using MTX at doses of > 8mg/week for RA patients of > 75 years of age（n=80, at July 2022）to reduce the dose of MTX. We investigated the change in the dose of MTX at 9 months, added other antirheumatic drugs, and changes in disease activity score 28-erythrocyte sedimentation rate（DAS28-ESR）.
Results:
The MTX dose was significantly reduced（from 9.0 ± 1.5mg/week to 7.7 ± 2.2mg/week, p<0.001）. MTX was increased in 1 patient, unchanged in 45 patients, and reduced in 34 patients. The DAS28-ESR remained unchanged in 24 patients who had been recorded.
Conclusion:
The dose of MTX was significantly reduced by the caution alert, but the disease activity of RA did not change, possibly due to unnoticed renal dysfunction. The caution alert appeared to be effective in preventing the side effects of MTX in elderly patients with RA.
