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Concurrent use of methotrexate and celecoxib increases risk of silent liver fibrosis in rheumatoid arthritis patients with subclinical reduced kidney function

 Jin Su Park  ;  Min-Chan Park  ;  Yong-Beom Park  ;  Soo-Kon Lee  ;  Sang-Won Lee 
 CLINICAL RHEUMATOLOGY, Vol.33(10) : 1415-1423, 2014 
Journal Title
Issue Date
Adult ; Aged ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/drug therapy* ; Arthritis, Rheumatoid/physiopathology ; Celecoxib ; Cross-Sectional Studies ; Cyclooxygenase 2 Inhibitors/therapeutic use ; Drug Therapy, Combination ; Female ; Glomerular Filtration Rate/physiology ; Humans ; Incidence ; Kidney/physiopathology* ; Liver Cirrhosis/chemically induced* ; Liver Cirrhosis/epidemiology* ; Liver Cirrhosis/physiopathology ; Male ; Methotrexate/therapeutic use* ; Middle Aged ; Multivariate Analysis ; Pilot Projects ; Pyrazoles/therapeutic use* ; Risk Factors ; Sulfonamides/therapeutic use* ; Time Factors ; Treatment Outcome
Celecoxib ; Estimated glomerular filtration rate ; Liver fibrosis ; Methotrexate ; Rheumatoid arthritis ; Transient elastography
We evaluated the effects of concurrent use of methotrexate and celecoxib on silent liver and kidney damages in rheumatoid arthritis (RA) patients. We enrolled 92 RA patients with normal laboratory results related to liver and kidney functions, who had received methotrexate and celecoxib concurrently over 6 months. Liver stiffness measurement (LSM) using transient elastography and ultrasonography were performed along with blood and urine tests. Estimated glomerular filtration rate (eGFR) was calculated by both the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) equations. Initial eGFR represented kidney function at the time of the initiation of celecoxib. The cutoff for abnormal LSM values was adopted as 5.3 kPa. The optimal cutoff of each eGFR for abnormal LSM values was also calculated. The median age of patients was 55 years old (74 women). The median LSM was 4.4 kPa and the median eGFRs and median initial eGFRs ranged from 89 to 99 mL/min/1.73 m2. The cumulative doses of methotrexate and celecoxib and their concurrent administration duration did not affect LSM values and eGFRs. Both eGFRs were significantly associated with LSM values. Patients with initial eGFR(CKD-EPI), initial eGFR(MDRD), and eGFR(CKD-EPI) below each optimal cutoff had significantly high risks for silent liver fibrosis (RR 9.4, 10.3, and 4.4, p < 0.001, respectively). Both initial eGFRs (CKD-EPI and MDRD) and eGFR (CKD-EPI) were significant predictors for the development of silent liver fibrosis in RA patients who had received methotrexate and celecoxib concurrently for at least 6 months.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Min Chan(박민찬) ORCID logo https://orcid.org/0000-0003-1189-7637
Park, Yong Beom(박용범)
Park, Jin Su(박진수)
Lee, Sang Won(이상원) ORCID logo https://orcid.org/0000-0002-8038-3341
Lee, Soo Kon(이수곤)
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