Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long‐term follow‐up of predictors, surveillance, and outcome in clinical practice
Identifieur interne : 000634 ( Main/Exploration ); précédent : 000633; suivant : 000635Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long‐term follow‐up of predictors, surveillance, and outcome in clinical practice
Auteurs : Johanna Karlsson Sundbaum ; Niclas Eriksson ; P R Hallberg ; Niklas Lehto ; Mia Wadelius ; Eva BaecklundSource :
- International Journal of Rheumatic Diseases [ 1756-1841 ] ; 2019.
Abstract
To assess predictors of alanine aminotransferase (ALT) elevation in methotrexate (MTX) treated rheumatoid arthritis (RA) patients, and to describe the monitoring of liver enzymes, including handling and outcome of elevated ALT.
All RA patients starting MTX in January, 2005 to April, 2013 at a rheumatology clinic, (Uppsala University Hospital, Sweden) were identified from electronic medical records. Clinical and laboratory data were obtained from medical records, supplemented by telephone interviews. Predictors for ALT >1.5× over the upper limit of normal (ULN) were identified by multiple regression analysis.
The study comprised 213 RA patients starting MTX. During a mean follow‐up of 4.3 years, 6288 ALT tests were performed; 7% of tests with ALT were >ULN. ALT >1.5× ULN was observed in 44 (21%) patients and the strongest predictor was a pre‐treatment elevation of ALT (adjusted odds ratio = 6.8, 95% CI 2.2‐20.5). Recurrent elevations occurred in 70% of patients who continued treatment, and the proportion was similar in those with and without interventions, for example MTX dose reduction (67% vs 73%,
Only a small number of ALT tests performed during MTX therapy in RA capture an elevation. A pre‐treatment elevation of ALT was the strongest predictor for early and recurrent ALT elevations during therapy. This study supports a more individualized approach to monitoring and handling of ALT elevations during MTX therapy in RA than recommended in current guidelines.
Url:
DOI: 10.1111/1756-185X.13576
PubMed: 31012257
PubMed Central: 6767545
Affiliations:
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id="apl13576-aff-0003"></nlm:aff></affiliation></author><author><name sortKey="Lehto, Niklas" sort="Lehto, Niklas" uniqKey="Lehto N" first="Niklas" last="Lehto">Niklas Lehto</name><affiliation><nlm:aff id="apl13576-aff-0002"></nlm:aff></affiliation></author><author><name sortKey="Wadelius, Mia" sort="Wadelius, Mia" uniqKey="Wadelius M" first="Mia" last="Wadelius">Mia Wadelius</name><affiliation><nlm:aff id="apl13576-aff-0003"></nlm:aff></affiliation></author><author><name sortKey="Baecklund, Eva" sort="Baecklund, Eva" uniqKey="Baecklund E" first="Eva" last="Baecklund">Eva Baecklund</name><affiliation><nlm:aff id="apl13576-aff-0001"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">31012257</idno><idno type="pmc">6767545</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767545</idno><idno type="RBID">PMC:6767545</idno><idno type="doi">10.1111/1756-185X.13576</idno><date when="2019">2019</date><idno type="wicri:Area/Pmc/Corpus">000639</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000639</idno><idno type="wicri:Area/Pmc/Curation">000639</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000639</idno><idno type="wicri:Area/Pmc/Checkpoint">000584</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000584</idno><idno type="wicri:Area/Ncbi/Merge">000560</idno><idno type="wicri:Area/Ncbi/Curation">000560</idno><idno type="wicri:Area/Ncbi/Checkpoint">000560</idno><idno type="wicri:doubleKey">1756-1841:2019:Karlsson Sundbaum J:methotrexate:treatment:in</idno><idno type="wicri:Area/Main/Merge">000634</idno><idno type="wicri:Area/Main/Curation">000634</idno><idno type="wicri:Area/Main/Exploration">000634</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long‐term follow‐up of predictors, surveillance, and outcome in clinical practice</title><author><name sortKey="Karlsson Sundbaum, Johanna" sort="Karlsson Sundbaum, Johanna" uniqKey="Karlsson Sundbaum J" first="Johanna" last="Karlsson Sundbaum">Johanna Karlsson Sundbaum</name><affiliation><nlm:aff id="apl13576-aff-0001"></nlm:aff></affiliation><affiliation><nlm:aff id="apl13576-aff-0002"></nlm:aff></affiliation></author><author><name sortKey="Eriksson, Niclas" sort="Eriksson, Niclas" uniqKey="Eriksson N" first="Niclas" last="Eriksson">Niclas Eriksson</name><affiliation><nlm:aff id="apl13576-aff-0003"></nlm:aff></affiliation></author><author><name sortKey="Hallberg, P R" sort="Hallberg, P R" uniqKey="Hallberg P" first="P R" last="Hallberg">P R Hallberg</name><affiliation><nlm:aff id="apl13576-aff-0003"></nlm:aff></affiliation></author><author><name sortKey="Lehto, Niklas" sort="Lehto, Niklas" uniqKey="Lehto N" first="Niklas" last="Lehto">Niklas Lehto</name><affiliation><nlm:aff id="apl13576-aff-0002"></nlm:aff></affiliation></author><author><name sortKey="Wadelius, Mia" sort="Wadelius, Mia" uniqKey="Wadelius M" first="Mia" last="Wadelius">Mia Wadelius</name><affiliation><nlm:aff id="apl13576-aff-0003"></nlm:aff></affiliation></author><author><name sortKey="Baecklund, Eva" sort="Baecklund, Eva" uniqKey="Baecklund E" first="Eva" last="Baecklund">Eva Baecklund</name><affiliation><nlm:aff id="apl13576-aff-0001"></nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Rheumatic Diseases</title><idno type="ISSN">1756-1841</idno><idno type="eISSN">1756-185X</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><sec id="apl13576-sec-0001"><title>Aim</title><p>To assess predictors of alanine aminotransferase (ALT) elevation in methotrexate (MTX) treated rheumatoid arthritis (RA) patients, and to describe the monitoring of liver enzymes, including handling and outcome of elevated ALT.</p></sec><sec id="apl13576-sec-0002"><title>Methods</title><p>All RA patients starting MTX in January, 2005 to April, 2013 at a rheumatology clinic, (Uppsala University Hospital, Sweden) were identified from electronic medical records. Clinical and laboratory data were obtained from medical records, supplemented by telephone interviews. Predictors for ALT >1.5× over the upper limit of normal (ULN) were identified by multiple regression analysis.</p></sec><sec id="apl13576-sec-0003"><title>Results</title><p>The study comprised 213 RA patients starting MTX. During a mean follow‐up of 4.3 years, 6288 ALT tests were performed; 7% of tests with ALT were >ULN. ALT >1.5× ULN was observed in 44 (21%) patients and the strongest predictor was a pre‐treatment elevation of ALT (adjusted odds ratio = 6.8, 95% CI 2.2‐20.5). Recurrent elevations occurred in 70% of patients who continued treatment, and the proportion was similar in those with and without interventions, for example MTX dose reduction (67% vs 73%, <italic>P</italic> = 0.43). Seven patients (3%) permanently stopped MTX due to ALT elevation, and two were eventually diagnosed with non‐alcoholic fatty liver disease. No patient developed hepatic failure.</p></sec><sec id="apl13576-sec-0004"><title>Conclusion</title><p>Only a small number of ALT tests performed during MTX therapy in RA capture an elevation. A pre‐treatment elevation of ALT was the strongest predictor for early and recurrent ALT elevations during therapy. This study supports a more individualized approach to monitoring and handling of ALT elevations during MTX therapy in RA than recommended in current guidelines.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list></list><tree><noCountry><name sortKey="Baecklund, Eva" sort="Baecklund, Eva" uniqKey="Baecklund E" first="Eva" last="Baecklund">Eva Baecklund</name><name sortKey="Eriksson, Niclas" sort="Eriksson, Niclas" uniqKey="Eriksson N" first="Niclas" last="Eriksson">Niclas Eriksson</name><name sortKey="Hallberg, P R" sort="Hallberg, P R" uniqKey="Hallberg P" first="P R" last="Hallberg">P R Hallberg</name><name sortKey="Karlsson Sundbaum, Johanna" sort="Karlsson Sundbaum, Johanna" uniqKey="Karlsson Sundbaum J" first="Johanna" last="Karlsson Sundbaum">Johanna Karlsson Sundbaum</name><name sortKey="Lehto, Niklas" sort="Lehto, Niklas" uniqKey="Lehto N" first="Niklas" last="Lehto">Niklas Lehto</name><name sortKey="Wadelius, Mia" sort="Wadelius, Mia" uniqKey="Wadelius M" first="Mia" last="Wadelius">Mia Wadelius</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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