Alcohol Consumption with Methotrexate: Is Any Amount Safe?

Consumption of 14 or less units of alcohol per week does not appear to be associated with increased risk of liver damage in patients with rheumatoid arthritis (RA) taking methotrexate, according to the results of a recent study.

Although patients taking methotrexate for the treatment of RA are advised to limit alcohol intake due to the risk of hepatotoxicity, evidence for this association is limited.
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In order to quantify this potential risk, researchers conducted a study of the medical records of 11,839 patients with RA from the Clinical Practice Research Datalink who began methotrexate between 1987 and 2016. The researchers defined hepatotoxicity as transaminitis (alanine transaminase or aspartate aminotransferase more than 3-times the upper limit of normal).

Overall, 530 episodes of transaminitis occurred in 47,090 person-years of follow-up. Increased weekly alcohol consumption as a continuous variable was associated with an increased risk of transaminitis, with an adjusted hazard ratio of 1.01 per unit consumed. Consumption of 15 to 21 units per week was associated with possible increased risk of hepatotoxicity, while consumption of 21 units or more per week significantly increased the risk.

“In this study, we have demonstrated that the risk of transaminitis in patients with RA taking MTX does increase with increasing levels of alcohol consumption. However, the risk in those patients who consume ≤14 units of alcohol per week is no greater than those who do not drink alcohol.

—Michael Potts

Reference:

Humphreys JH, Warner A, Costello R, et al. Quantifying the hepatotoxic risk of alcohol consumption in patients with rheumatoid arthritis taking methotrexate [published online March 23, 2017]. doi:10.1136/annrheumdis-2016-210629.