Comparative risks of mortality, cardiovascular events, and dementia with methotrexate versus hydroxychloroquine in rheumatoid arthritis: a retrospective cohort study

In this large, real-world observational study, RA patients initiating HCQ had a higher 10-year risk association for ESRD, ILD, PAH, NSTEMI, and all-cause mortality versus MTX initiators. These findings highlight potential differences in systemic risk profiles and are hypothesis generating. However, the results must be interpreted with significant caution due to major limitations, including the potential for residual confounding from unmeasured variables like disease severity and the absence of adherence data. Further prospective research that addresses these limitations is warranted to confirm these associations and explore underlying mechanisms.