{"id":24009,"date":"2026-05-12T16:36:52","date_gmt":"2026-05-12T20:36:52","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=24009"},"modified":"2026-05-14T16:41:46","modified_gmt":"2026-05-14T20:41:46","slug":"risk-of-serious-adverse-events-and-death-with-low-dose-methotrexate-versus-hydroxychloroquine-in-adults-receiving-dialysis","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/risk-of-serious-adverse-events-and-death-with-low-dose-methotrexate-versus-hydroxychloroquine-in-adults-receiving-dialysis\/","title":{"rendered":"Risk of serious adverse events and death with low-dose methotrexate versus hydroxychloroquine in adults receiving dialysis"},"content":{"rendered":"<p><strong>Background<\/strong> \u2014 Several case reports have linked low-dose methotrexate to serious adverse events, including death, in dialysis patients. We compared the risk of serious adverse events in dialysis patients initiating low-dose methotrexate versus hydroxychloroquine.<\/p>\n<p><strong>Methods<\/strong> \u2014 Using linked healthcare databases in Ontario, Canada (1997\u20132020), we identified 55 new users of low-dose methotrexate and 407 new users of hydroxychloroquine.<\/p>\n<p>The primary outcome was the 90-day risk of death or hospitalization with myelosuppression, sepsis, pneumotoxicity, or hepatotoxicity. Adjusting for age, sex, and a proxy for polypharmacy, a modified Poisson regression was used to estimate adjusted risk ratios (aRR), and a binomial regression was used to estimate adjusted risk differences (aRD).<\/p>\n<p><strong>Results<\/strong> \u2014 The median prescribed dose was 10\u2009mg\/week (IQR, 10\u201317.5) for methotrexate and 300\u2009mg\/day (IQR, 200\u2013400) for hydroxychloroquine. The primary outcome occurred in 16\/55 low-dose methotrexate users (29.1%) and in 29\/407 hydroxychloroquine users (7.1%); aRR: 3.14 (95% CI, 1.75 to 5.63); aRD: 19.5% (95% CI, 7.5% to 31.4%). Findings were consistent across sensitivity analyses.<\/p>\n<p><strong>Conclusion<\/strong> \u2014 Low-dose methotrexate should be avoided in dialysis patients whenever possible, and alternative DMARDs should be considered.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background \u2014 Several case reports have linked low-dose methotrexate to serious adverse events, including death, in dialysis patients. We compared the risk of serious adverse events in dialysis patients initiating low-dose methotrexate versus hydroxychloroquine. Methods \u2014 Using linked healthcare databases in Ontario, Canada (1997\u20132020), we identified 55 new users of low-dose methotrexate and 407 new [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[49,56],"migration-helper-qa-sample-set":[],"class_list":["post-24009","journal_article","type-journal_article","status-publish","hentry","topic-kidney-disease","topic-pharmacoepidemiology-and-drug-safety"],"acf":{"citation":"Muanda FT, Blake PG, Weir MA, Ahmadi F, Omrani MA, Abdullah SS, McArthur E, Sontrop JM, Urquhart BL, Garg AX. <em>Semin Dial<\/em>. 2026; May 12 [Epub ahead of print].","source_url":"https:\/\/doi.org\/10.1111\/sdi.70035","ices_scientist":[13130,1127,22472,1242],"site":[6739],"research_program":[6743],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Risk of serious adverse events and death with low-dose methotrexate versus hydroxychloroquine in adults receiving dialysis<\/title>\n<meta name=\"description\" content=\"Background \u2014 Several case reports have linked low-dose methotrexate to serious adverse events, including death, in dialysis patients. 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