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Methotrexate in CKD — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyMethotrexate in CKDSCE Rheumatology

A 50-year-old woman on Methotrexate 15 mg weekly attends for routine blood monitoring. Her eGFR has dropped from 65 to 48 mL/min over 6 months. She feels well. According to BSR 2025 what action is required?

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Correct answer: E — Review Methotrexate dose consider reduction and increase monitoring frequency

Declining renal function on Methotrexate requires dose review because Methotrexate is primarily renally excreted and impaired clearance increases toxicity risk. BSR 2025 csDMARD guidelines recommend reducing the Methotrexate dose in proportion to the decline in renal function and increasing monitoring frequency. An eGFR decline from 65 to 48 (now moderate CKD stage 3b) warrants a dose reduction and investigation of the cause. Methotrexate may still be used cautiously at reduced doses in CKD but should generally not exceed 10-15 mg weekly with moderate impairment.

Reference: BSR 2025 - Guideline for prescription and monitoring of conventional synthetic DMARDs