The Drug-Induced Respiratory Disease Website and App

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I.g

Pulmonary fibrosis

Literature scrutiny indicates that MTX per se probably does not produce pulmonary fibrosis. A handful cases suggest acute methotrexate lung may aggravate/deteriorate preexisting rheumatoid arthritis-/CTD-associated ILD. MTX does not produce an IPF-like pattern (PMID 23791462; 30919996)

Publications

Affleck A, Goudie A, Smith R

Fatal, incidental, idiopathic pulmonary fibrosis in a patient receiving long-term low-dose methotrexate for psoriasis.

Clinical and experimental dermatology 2019 Jul;44;591-592 — 2019 Jul — 591-592

Gochuico BR, Avila NA, Chow CK, Novero LJ, Wu HP, Ren P, MacDonald SD, Travis WD, Stylianou MP, Rosas IO

Progressive preclinical interstitial lung disease in rheumatoid arthritis.

Archives of internal medicine 2008 Jan 28;168;159-66 — 2008 Jan 28 — 159-66

van der Veen MJ, Dekker JJ, Dinant HJ, van Soesbergen RM, Bijlsma JW

Fatal pulmonary fibrosis complicating low dose methotrexate therapy for rheumatoid arthritis.

The Journal of rheumatology 1995 Sep;22;1766-8 — 1995 Sep — 1766-8

Ridley MG, Wolfe CS, Mathews JA

Life threatening acute pneumonitis during low dose methotrexate treatment for rheumatoid arthritis: a case report and review of the literature.

Annals of the rheumatic diseases 1988 Sep;47;784-8 — 1988 Sep — 784-8

Kaplan RL, Waite DH

Progressive interstitial lung disease from prolonged methotrexate therapy.

Archives of dermatology 1978 Dec;114;1800-2 — 1978 Dec — 1800-2

Bedrossian CW, Miller WC, Luna MA

Methotrexate-induced diffuse interstitial pulmonary fibrosis.

Southern medical journal 1979 Mar;72;313-8 — 1979 Mar — 313-8