Methotrexate use reduces mortality risk in rheumatoid arthritis: A systematic review and meta-analysis of cohort studies

Rheumatoid arthritis(RA) sufferers have a higher mortality risk than the healthy population, and methotrexate (MTX) as a base drug for RA treatment is believed to affect patients mortality. Systematic analyses of MTX and RA mortality are lacking and it is still confused about the role of MTX on the long-term prognosis of RA.We performed a systematic review and meta-analysis to identify any influence of MTX on mortality among RA patients. Hazard ratio(HR) for all-cause mortality were pooled in a meta-analysis, and HR for mortality from RA with cardiovascular diseases (RA-CVD) and mortality from RA associated interstitial lung diseases (RA-ILD) were also pooled and analyzed.Fifteen studies were eventually included. Meta-analysis of data from 15 studies on overall mortality showed that MTX significantly reduced mortality in patients with RA (HR = 0.59, 95%CI 0.50-0.71, P < 0.001), MTX was independently associated with decreased RA-CVD-induced mortality (HR = 0.72, 95%CI 0.53-0.97, P = 0.031). In the meanwhile, MTX was also significantly reduced mortality in RA-ILD (HR = 0.44, 95%CI 0.20-0.95, P = 0.037).MTX can significantly decrease the overall mortality for RA patients, specifically, RA-CVD- and RA-ILD-induced mortality were reduced.