Many patients taking methotrexate experience side effects but usually they are mild. Discontinuation rates of methotrexate were less than sulfasalazine, gold, and penicillamine -- but more than plaquenil. While 13% of patients experienced elevated liver enzymes -- only 3.7% had to stop using methotrexate due to liver toxicity.
Methotrexate was not tied to an increased risk of infections. Two of the studies assessed the relationship of methotrexate to cardiovascular disease while being treated. One concluded there was no increased risk of cardiovascular disease -- while the other suggested there may even be a reduced cardiovascular risk while taking methotrexate.
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