Moderate drinkers not at risk when taking a widely-used arthritis medicine
People taking a common rheumatoid arthritis medicine
are not at increased risk of liver damage if they stick
to 14 units of alcohol a week or fewer, a new study
from The University of Manchester has found.
Methotrexate is a drug taken, often over long periods
of time, to limit or prevent joint damage and disability.
People who take methotrexate are often advised to
abstain from alcohol as both methotrexate and alcohol
are known to increase the risks of liver damage.
However, it is not known whether drinking modest
amounts of alcohol is safe during methotrexate
therapy.
The new study by The University of Manchester,
published in the journal Annals of the Rheumatic
Diseases and funded by Arthritis Research UK, has
drawn upon the medical records of almost 12,000
people with rheumatoid arthritis taking the drug who
had a record of the levels of alcohol they drank and
who had routine blood monitoring test results.
The researchers found that increased use of alcohol
did indeed correspond to increased liver damage, but
at 14 units or fewer there was no heightened risk.
Dr Natalie Carter, Head of Research Liaison and
Evaluation at Arthritis Research UK, said: “We know
that methotrexate can be an effective drug for
treating arthritis . As it can interact with other
medicines and alcohol it is important that people with
arthritis have information about their medication in
order to manage their arthritis safely and effectively.
Arthritis Research UK invests in exceptional science to
find treatments and information that let people push
back the limits these conditions cause. This research
adds to the knowledge we have around methotrexate
and its effects in people with rheumatoid arthritis,
which can help people make informed decisions about
their treatment. We would recommend that people who
take methotrexate to speak to their rheumatologist for
advice about drinking alcohol whilst on this drug.”
Dr Jenny Humphreys, an NIHR Clinical Lecturer at The
University of Manchester’s Arthritis Research UK
Centre for Epidemiology, led the study. She said: “In
the past there’s not been clear guidance on what
effects different amounts of alcohol have on these
people, so doctors often err on the side of caution and
recommend abstinence.
“As a result, some people choose to decline
methotrexate so they can continue to enjoy a drink,
thereby missing out on the possible benefits of the
medication. Alternatively, some people may go totally
without alcohol after starting methotrexate: if they like
to drink in moderation, the quality of their life may be
affected.”
With a pint of 5.2% ABV beer containing three units
and a 250ml glass of 14% ABV wine containing 3.5,
the findings show that people can drink in moderation,
while still benefitting from the drug.
The data used in the study came from the Clinical
Practice Research Datalink, a UK general practice
database. The researchers identified 11,839 people
with rheumatoid arthritis who were taking
methotrexate and had at least six liver function test
results per year. Of these, 530 developed abnormal
liver function tests.
Although there was no increased risk associated with
drinking 14 units or less compared to people who
drank no alcohol, people who drank 15-21 units had a
33% increased probability of liver damage and this rose
to 81% in the group that drank more than 21 units.
Professor Will Dixon, Director of the Arthritis Research
UK Centre for Epidemiology at The University of
Manchester, who is also a rheumatologist at Salford
Royal NHS Foundation Trust, believes that the results
can provide important guidance for doctors who are
prescribing methotrexate.
He added: “This is the first study to provide estimates
of risk of liver damage for different levels of alcohol
consumption in this drug. It also quantifies the risk for
doctors so they can be clear about the extent to
which different levels of alcohol will cause problems
across a population of patients taking methotrexate.”
Source: MNT
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