Another Study Putting the Frequency of Methotrexate Induced Hair Loss at Approximately 10 %

10 % of Rheumatoid Arthritis Patients Report MTX induced Hair Loss

It’s difficult to get a convincing number as to how common hair loss occurs among methotrexate users. In the prior literature that number ranges from 0 to 26 %. In fact, I wrote an article about the issue not too long ago.

MTX Induced Hair Loss: How Frequently Does it Occur?

A new study in the rheumatology literature supports the notion that somewhere in the ballpark of 5-10 % is probably pretty reasonable.

Sherbini et al, 2022

Researchers from Manchester, UK set up out examine the frequency of adverse events in those patients with rheumatoid arthritis starting methotrexate. This was not a study focusing solely on hair loss but the hair loss aspects of this study were of course the areas of the study that interested me.

Patients in the study were 18 years or older and had been diagnosed with rheumatoid arthritis in the past 2 years and had now newly started methotrexate. The authors look at various adverse events at the 0-6 month mark, the 6-12 month mark and at anytime during the first 1 year.

A total of 1069 patients were included in the analysis. Overall, 77.5% experienced at least one adverse event. The most commonly reported adverse events from methotrexate were: gastrointestinal (42.0%), neurological (28.6%), mucocutaneous (26.0%), pulmonary (20.9%), elevated alanine transaminase (18.0%) and haematologic (5.6%).

In total, 9.2 % of patients had concerns about hair loss over the 12 month follow up. 6 % of patients had hair loss issues in the first 6 months and 4.2 % had concerns during month 6 to 12. Female gender, alcohol consumption, and higher HAQ (Health Assessment Questionnaire Disability Index) score were associated with a greater likelihood of reporting hair loss. The strongest link was for female gender with females being 4.87 times more likely to have hair loss with MTX than men.

Conclusion

It’s challenging to pinpoint exactly how commonly hair loss occurs among patients with immune diseases using low dose (10-25 mg weekly) methotrexate. The data ranges from 0 to 26 % but in general, a number somewhere between 5 - 10 % seems reasonable to quote patients. Whether patients with rheumatoid arthritis have a difference chance of hair loss with methotrexate than patients with autoimmune hair loss diseases like lichen planopilaris or frontal fibrosing alopecia or alopecia areata remains to be determined.

The study highlights that women may be more susceptible to hair loss from methotrexate than men. More studies in the hair loss field will be helpful to determine if this is applicable to our patient populations.

Reference

Sherbini et al. Rates and predictors of methotrexate-related adverse events in patients with early rheumatoid arthritis: results from a nationwide UK study. Rheumatology (Oxford). 2022 Jan 25;keab917.