Methotrexate and strongyloidiasis

[Fred]

This study doesn't mention psoriasis but as it mentions "Corticosteroids were taken in 18/21 patients on low‐dose Methotrexate (MTX)" I thought it may be of interest to some of our members that use it.

Quote:

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Objective:
Rheumatologic disease patients receiving immunomodulating drugs such as methotrexate (MTX) have increased infection rates. Strongyloides, a global endemic intestinal parasite, can cause significant or fatal disease in immunocompromised patients. The risk of serious Strongyloides infection with MTX dosed for rheumatologic disease is unknown.

Methods:
We performed a systematic literature review searching EMBASE, Medline and Web of Science databases. All studies reporting humans exposed to MTX and tested for Strongyloides were reviewed. Exclusion criteria were bone marrow transplantation, intrathecal route and MTX exposure completed >1 year prior to clinically apparent Strongyloides disease.

Results:
After excluding duplicates, 294 articles were reviewed. Of these, 29 cases were described in 27 papers. Twenty cases (69%) had an underlying rheumatologic or dermatologic disease, the rest a haematologic disease. Hyperinfection or dissemination was found in 59% of cases (52% low‐dose MTX; 75% high‐dose MTX). Death occurred in 34% of cases (19% low‐dose MTX; 75% high‐dose MTX, p<0.01). All eight patients on high‐dose MTX received other immunosuppressants. Corticosteroids were taken in 18/21 patients on low‐dose MTX. One of the three patients on MTX monotherapy had hyperinfection syndrome. None had disseminated Strongyloides.

Conclusions:
Serious Strongyloides infection can occur with low‐dose MTX particularly when given with other immunosuppression. Global travel and greater awareness of rheumatologic conditions in low‐middle‐income countries will increase exposure of individuals prescribed MTX (with or without corticosteroids) to Strongyloides. Strongyloides screening and treatment should be considered for individuals receiving low dose MTX therapy, particularly if combined with additional immunosuppression.

Source: onlinelibrary.wiley.com

*Early view funding unknown

[jiml]

An interesting article Fred and although a releatively small study it would be interesting to see a study done with psoriasis sufferers on methotrexate

Is there a problem with strongyloides generally it's not something I've come across or heard of and do you know how they detect it ?

[Fred]

An interesting article Fred and although a releatively small study it would be interesting to see a study done with psoriasis sufferers on methotrexate

Is there a problem with strongyloides generally it's not something I've come across or heard  of and do you know how they detect it ?

I don't know Jim.

All I know is Methotrexate is poison and should no longer be used to treat psoriasis.

*That is my own opinion and not one of this news post.

[Bill]

Fred, I am sure that everyone with a long history of moderate to severe psoriasis has an opinion of methotrexate. I am glad that it remains a treatment option as it is undeniably a great help for some, so I think its removal as a treatment option would be harmful.

[Fred]

Fred, I am sure that everyone with a long history of moderate to severe psoriasis has an opinion of methotrexate. I am glad that it remains a treatment option as it is undeniably a great help for some, so I think its removal as a treatment option would be harmful.

We will agree to disagree Bill.

[Bill]

No worries, Fred. You at least have taken the stuff, so you are one up on me.

Cheers