Clinical Rheumatology

, Volume 37, Issue 12, pp 3215–3220 | Cite as

Safety of the concomitant use of methotrexate and a prophylactic dose of trimethoprim-sulfamethoxazole

  • Oh Chan Kwon
  • Jung Sun Lee
  • Yong-Gil Kim
  • Chang-Keun Lee
  • Bin Yoo
  • Seokchan HongEmail author
Original Article


The objective of this study was to investigate risk factors for cytopenia when a prophylactic dose of trimethoprim-sulfamethoxazole (TMP-SMX) was co-administered with methotrexate (MTX). Patients who received MTX with or without a prophylactic dose of TMP-SMX were included. Patients who received a therapeutic dose of TMP-SMX were excluded. The MTX-alone and MTX with TMP-SMX groups (MTX group and MTX + TMP-SMX group, respectively) were matched in a 4:1 ratio according to age, creatinine level, mean corpuscular volume and MTX dose. Cytopenia was defined as a haemoglobin level decrease by > 2 g/dl, platelet count of < 150,000/mm3 or white blood cell count of < 3500/mm3. The Cox proportional hazards model was used to evaluate risk factors for cytopenia in patients administered with MTX. The incidence of cytopenia did not significantly differ between the MTX group and MTX + TMP-SMX group (5.0 vs 5.7%, p > 0.999). According to the Cox proportional hazards model, chronic liver disease (hazard ratio [HR] 5.829, 95% confidence interval [CI] 1.211–28.063, p = 0.028) was associated with an increased risk of cytopenia. However, the concomitant use of a prophylactic dose of TMP-SMX (HR 1.717, 95% CI 0.352–8.371, p = 0.504) was not significantly associated with an increased risk of cytopenia. Compared with the use of MTX alone, the concomitant use of MTX with a prophylactic dose of TMP-SMX was not significantly associated with an increased risk of cytopenia. Thus, a prophylactic dose of TMP-SMX can be safely used with MTX.


Cytopenia Methotrexate Myelosuppression Trimethoprim-sulfamethoxazole 


Compliance with ethical standards

The Institutional Review Board of the Asan Medical Center, Seoul, South Korea, approved this study (IRB No.: 2017-0623).




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  1. 1.Division of Rheumatology, Department of MedicineUniversity of Ulsan, College of Medicine, Asan Medical CenterSeoulSouth Korea

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