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Is methotrexate safe for men with an immune-mediated inflammatory disease and an active desire to become a father? Results of a prospective cohort study (iFAME-MTX)
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  • Published on:
    Correspondence on ‘Is methotrexate safe for men with an immune-mediated inflammatory disease and an active desire to become a father? Results of a prospective cohort study (iFAME-MTX)’ and the importance of the precautionary principle
    • Renaud FELTEN, Rheumatologist Centre d’Investigation Clinique, Inserm 1434, Hôpitaux Universitaires de Strasbourg, France
    • Other Contributors:
      • Marc SCHERLINGER, Rheumatologist

    Dear Editor,
    We read with great interest the paper published by Perez-Garcia et al [1] on ‘Is methotrexate safe for men with an immune-mediated inflammatory disease and an active desire to become a father? Results of a prospective cohort study (iFAME-MTX)’. The authors bring original data to address an important and controversial topic regarding the use of MTX in men with immune-mediated inflammatory diseases (IMIDs) who desire to father a child. They prospectively evaluated the testicular toxicity profile of MTX through quantitative and qualitative study of the sperm from treated patients. The strength of this study lies in its prospective design and comprehensive evaluation of various fertility markers in men exposed to MTX such as semen parameters, reproductive hormone levels, sperm DNA fragmentation index, and the presence of MTX-polyglutamates (MTX-PG) in spermatozoa. The author included three distinct groups, namely MTX-starters, MTX-chronic, and healthy controls, to provide a comparative analysis and highlight the impact of both short-term and long-term MTX exposure on male fertility. They observe that MTX exposure in men with IMIDs does not significantly affect conventional semen parameters, reproductive endocrine markers, or sperm DNA fragmentation index. These results provide reassurance regarding the start or continuation of MTX therapy in men planning to father a child, which align with the recent recommendations from the American College of Rheumatology...

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    Conflict of Interest:
    None declared.