Objectives We evaluated the effects of concurrent use of methotrexate and celecoxib on silent liver and kidney damages in rheumatoid arthritis (RA) patients.
Methods We enrolled 92 RA patients with normal 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 CKD-EPI and MDRD equations. Initial eGFR was calculated with variables 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.
Results The median age (female: 80.4%) was 55 years. The median LSM was 4.4 kPa and the median eGFRs and initial eGFRs were mostly belonging to normal reference ranges. The cumulative doses of methotrexate and celecoxib and their concurrent administration duration did not affect LSM values and eGFRs. Among variables with significance, both eGFRs and initial eGFRs were significantly associated with LSM values. Patients with initial eGFR(CKD-EPI), initial eGFR(MDRD) and eGFR(CKD-EPI) below 66.5 mL/min/1.73m2 , 59.5 mL/min/1.73m2 , and 60 mL/min/1.73m2 (RR 9.4, 10.3 and 4.4, p<0.001, respectively) had significantly high risks of the potential of newly developed silent liver fibrosis, compared to those without (Table 1).
Conclusions Reduced kidney function rather than the cumulative dose or concurrent administration duration could predict the development of silent liver fibrosis in RA patients who had received methotrexate and celecoxib concurrently for at least 6 months.
Disclosure of Interest None declared
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