Key clinical point: The risk for bacterial infections significantly increased with concomitant use of methotrexate and glucocorticoids in patients with rheumatoid arthritis (RA) who were receiving biologic disease-modifying antirheumatic drugs (bDMARD), especially when the doses of concomitant methotrexate and glucocorticoids were ≥ 8 mg/week and ≥5 mg/day, respectively.
Major finding: Overall, the incidence of bacterial infections was 16.8%, with the highest incidence (25.5%) observed in patients receiving combination therapy with methotrexate ( ≥8 mg/week) and glucocorticoids ( ≥5 mg/day). Co-prescription of ≥5 mg/day glucocorticoids with an increasing methotrexate dose ( P = .013) and ≥8 mg/week methotrexate with an increasing glucocorticoid dose ( P = .009) significantly increased the risk for bacterial infections.
Study details: This retrospective cohort study included 2837 patients with RA who initiated bDMARD with concomitant conventional synthetic DMARD, methotrexate, or oral glucocorticoids.
Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.
Source: Ota R et al. Risk of infection from glucocorticoid and methotrexate interaction in patients with rheumatoid arthritis using biologics: A retrospective cohort study. Br J Clin Pharmacol. 2023 (Feb 8). Doi: 10.1111/bcp.15687