Can methotrexate influence sexual dysfunction in male patients? Analysis of the IIEF5 questionnaire and hormonal status

Objective: The aim of this study is to evaluate the impact of MTX on erectile function in male patients through the IIEF5 (International Index of Erectile Function) questionnaire and hormonal dosage.Methods: Male patients affected by inflammatory arthritis (Rheumatoid Arthritis [RA] or Psoriatic Arthritis [PsA]) with good disease control and treated with chronic MTX were enrolled. Age-matched patients affected by chronic arthritis not treated with MTX were enrolled as control. Each patient had a complete sexual hormone evaluation. IIEF5 questionnaire was administered to each patient.Results: 109 patients were included, 77 in the MTX group and 32 as controls. The median MTX dose was 10 mg (IQR 7.5) with a median MTX duration therapy of 8 years (IQR 17). The total IIEF5 score was lower in patients MTX exposed compared to the control group without a significant result. The total IIEF5 score of patients treated with MTX ≥ 5 years was statistically significantly lower when compared to those non-MTX exposed patients (17 [IQR 15] versus 20 [IQR 7.7]; p=0.04) and compared to those treated for < 5 years (17 [IQR 15] versus 20 [IQR 7]; p=0.01). A negative correlation was identified between the total IIEF5 score and MTX exposure (r= - 0.20 CI [-0.38 - -0.04]; p= 0.039). MTX exposure was still associated with a lower IIEF5 score when adjusted for age (β Estimate= -2.63; CI [-5.13 to -0.13]; p=0.039). Hormonal dosage was similar in both groups for all hormones evaluated.Conclusion: MTX exposure was associated with a lower IIEF5 score in male patients adjusted for age. The preliminary results need to be confirmed in larger prospective studies.