Methotrexate: long‐term safety and efficacy in an Australian consultant rheumatology practice
Identifieur interne : 001848 ( Main/Exploration ); précédent : 001847; suivant : 001849Methotrexate: long‐term safety and efficacy in an Australian consultant rheumatology practice
Auteurs : N. Varatharajan [Australie] ; I. G. S. Lim ; A. Anandacoomarasamy ; R. Russo ; K. Byth [Australie] ; D. G. Spencer ; N. Manolios ; G. B. Howe [Australie]Source :
- Internal Medicine Journal [ 1444-0903 ] ; 2009-04.
English descriptors
- Teeft :
- Adverse reaction, Adverse reactions, Arthritis, Arthritis rheum, Australasian, Authors journal compilation, Average duration, Biopsy, Blood monitoring, Cessation, Clinical impression, Clinical practice, Combination therapy, Common reason, Complete remission, Complete remission group, Current monitoring guidelines, Discontinuation rates, Effective medication, Females males, Folic, Folic acid, Gastrointestinal symptoms, Guideline, Hazard ratios, Median, Median duration, Median number, Median time, Methotrexate, Monitoring guidelines, Multiple sclerosis, Other causes, Other reasons, Physicians methotrexate outcomes table, Primary biliary cirrhosis, Primary outcome, Private practice, Range years, Remission, Remission status, Renal failure, Rheum, Rheumatoid, Rheumatoid arthritis, Rheumatology, Royal australasian college, Seronegative, Seronegative arthritis, Survival curves, Systemic lupus erythematosus, Tight control, Toxicity, Various subgroups, Vasculitis, Weekly dose, Western sydney, Westmead hospital.
Abstract
Background: The aim of this study was to evaluate the rate and cause of methotrexate (MTX) termination in clinical practice, describe the types of toxicities noted, assess the incidence of achieving remission in rheumatoid arthritis (RA) patients and review the appropriateness of current clinical guidelines for monitoring MTX treatment. Methods: A retrospective, case review of patients seen in a private rheumatology practice attached to a major Sydney Teaching Hospital was undertaken over an 18‐year period. The primary outcome was time to cessation of MTX. Results: Seven hundred and ninety patients satisfied the inclusion criteria. MTX was terminated in 272 patients (34.4%). Toxicity‐related discontinuation occurred in 93 patients (11.8%) and due to non‐adverse reactions in 179 patients. The median duration of therapy in these two groups was 2.0 and 2.9 years, respectively. There was no difference in the average maximum weekly dose of MTX. Of patients with RA, 47.5% were in remission at last follow up. Cox proportional hazards analyses showed that those of the female sex remained on treatment significantly longer than the male sex (hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.57–0.96; P = 0.014); patients with RA remained on treatment significantly longer than patients with seronegative arthritis (HR 0.56, 95%CI 0.42–0.74; P < 0.001). Being of the male sex aged more than 60 years and having a non‐RA diagnosis predisposed to stopping MTX earlier. Conclusion: MTX is a safe and effective medication. Notable remission rates are achievable in patients with RA with current conventional treatment protocols. MTX has a low toxicity profile and this study stresses the need to re‐evaluate and revise the current monitoring guidelines.
Url:
DOI: 10.1111/j.1445-5994.2009.01800.x
Affiliations:
Links toward previous steps (curation, corpus...)
- to stream Istex, to step Corpus: 001340
- to stream Istex, to step Curation: 001340
- to stream Istex, to step Checkpoint: 000773
- to stream Main, to step Merge: 001852
- to stream Main, to step Curation: 001848
Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Methotrexate: long‐term safety and efficacy in an Australian consultant rheumatology practice</title><author><name sortKey="Varatharajan, N" sort="Varatharajan, N" uniqKey="Varatharajan N" first="N." last="Varatharajan">N. Varatharajan</name></author><author><name sortKey="Lim, I G S" sort="Lim, I G S" uniqKey="Lim I" first="I. G. S." last="Lim">I. G. S. Lim</name></author><author><name sortKey="Anandacoomarasamy, A" sort="Anandacoomarasamy, A" uniqKey="Anandacoomarasamy A" first="A." last="Anandacoomarasamy">A. Anandacoomarasamy</name></author><author><name sortKey="Russo, R" sort="Russo, R" uniqKey="Russo R" first="R." last="Russo">R. Russo</name></author><author><name sortKey="Byth, K" sort="Byth, K" uniqKey="Byth K" first="K." last="Byth">K. Byth</name></author><author><name sortKey="Spencer, D G" sort="Spencer, D G" uniqKey="Spencer D" first="D. G." last="Spencer">D. G. Spencer</name></author><author><name sortKey="Manolios, N" sort="Manolios, N" uniqKey="Manolios N" first="N." last="Manolios">N. Manolios</name></author><author><name sortKey="Howe, G B" sort="Howe, G B" uniqKey="Howe G" first="G. B." last="Howe">G. B. Howe</name></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:DF968489323B8F50B2C2CE2BC06D1B88F325FBCE</idno><date when="2009" year="2009">2009</date><idno type="doi">10.1111/j.1445-5994.2009.01800.x</idno><idno type="url">https://api.istex.fr/ark:/67375/WNG-F6S7ZLCV-C/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">001340</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001340</idno><idno type="wicri:Area/Istex/Curation">001340</idno><idno type="wicri:Area/Istex/Checkpoint">000773</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Checkpoint">000773</idno><idno type="wicri:doubleKey">1444-0903:2009:Varatharajan N:methotrexate:long:term</idno><idno type="wicri:Area/Main/Merge">001852</idno><idno type="wicri:Area/Main/Curation">001848</idno><idno type="wicri:Area/Main/Exploration">001848</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main">Methotrexate: long‐term safety and efficacy in an Australian consultant rheumatology practice</title><author><name sortKey="Varatharajan, N" sort="Varatharajan, N" uniqKey="Varatharajan N" first="N." last="Varatharajan">N. Varatharajan</name><affiliation wicri:level="4"><orgName type="university">Université de Sydney</orgName><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Lim, I G S" sort="Lim, I G S" uniqKey="Lim I" first="I. G. S." last="Lim">I. G. S. Lim</name><affiliation><wicri:noCountry code="no comma">Department of Rheumatology and</wicri:noCountry></affiliation></author><author><name sortKey="Anandacoomarasamy, A" sort="Anandacoomarasamy, A" uniqKey="Anandacoomarasamy A" first="A." last="Anandacoomarasamy">A. Anandacoomarasamy</name><affiliation><wicri:noCountry code="no comma">Department of Rheumatology and</wicri:noCountry></affiliation></author><author><name sortKey="Russo, R" sort="Russo, R" uniqKey="Russo R" first="R." last="Russo">R. Russo</name><affiliation><wicri:noCountry code="no comma">Department of Rheumatology and</wicri:noCountry></affiliation></author><author><name sortKey="Byth, K" sort="Byth, K" uniqKey="Byth K" first="K." last="Byth">K. Byth</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Westmead Millennium Institute, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="Spencer, D G" sort="Spencer, D G" uniqKey="Spencer D" first="D. G." last="Spencer">D. G. Spencer</name><affiliation><wicri:noCountry code="no comma">Department of Rheumatology and</wicri:noCountry></affiliation></author><author><name sortKey="Manolios, N" sort="Manolios, N" uniqKey="Manolios N" first="N." last="Manolios">N. Manolios</name><affiliation><wicri:noCountry code="no comma">Department of Rheumatology and</wicri:noCountry></affiliation></author><author><name sortKey="Howe, G B" sort="Howe, G B" uniqKey="Howe G" first="G. B." last="Howe">G. B. Howe</name><affiliation></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Australie</country></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Internal Medicine Journal</title><title level="j" type="alt">INTERNAL MEDICINE JOURNAL</title><idno type="ISSN">1444-0903</idno><idno type="eISSN">1445-5994</idno><imprint><biblScope unit="vol">39</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="228">228</biblScope><biblScope unit="page" to="236">236</biblScope><biblScope unit="page-count">9</biblScope><publisher>Blackwell Publishing Asia</publisher><pubPlace>Melbourne, Australia</pubPlace><date type="published" when="2009-04">2009-04</date></imprint><idno type="ISSN">1444-0903</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1444-0903</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Adverse reaction</term><term>Adverse reactions</term><term>Arthritis</term><term>Arthritis rheum</term><term>Australasian</term><term>Authors journal compilation</term><term>Average duration</term><term>Biopsy</term><term>Blood monitoring</term><term>Cessation</term><term>Clinical impression</term><term>Clinical practice</term><term>Combination therapy</term><term>Common reason</term><term>Complete remission</term><term>Complete remission group</term><term>Current monitoring guidelines</term><term>Discontinuation rates</term><term>Effective medication</term><term>Females males</term><term>Folic</term><term>Folic acid</term><term>Gastrointestinal symptoms</term><term>Guideline</term><term>Hazard ratios</term><term>Median</term><term>Median duration</term><term>Median number</term><term>Median time</term><term>Methotrexate</term><term>Monitoring guidelines</term><term>Multiple sclerosis</term><term>Other causes</term><term>Other reasons</term><term>Physicians methotrexate outcomes table</term><term>Primary biliary cirrhosis</term><term>Primary outcome</term><term>Private practice</term><term>Range years</term><term>Remission</term><term>Remission status</term><term>Renal failure</term><term>Rheum</term><term>Rheumatoid</term><term>Rheumatoid arthritis</term><term>Rheumatology</term><term>Royal australasian college</term><term>Seronegative</term><term>Seronegative arthritis</term><term>Survival curves</term><term>Systemic lupus erythematosus</term><term>Tight control</term><term>Toxicity</term><term>Various subgroups</term><term>Vasculitis</term><term>Weekly dose</term><term>Western sydney</term><term>Westmead hospital</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: The aim of this study was to evaluate the rate and cause of methotrexate (MTX) termination in clinical practice, describe the types of toxicities noted, assess the incidence of achieving remission in rheumatoid arthritis (RA) patients and review the appropriateness of current clinical guidelines for monitoring MTX treatment. Methods: A retrospective, case review of patients seen in a private rheumatology practice attached to a major Sydney Teaching Hospital was undertaken over an 18‐year period. The primary outcome was time to cessation of MTX. Results: Seven hundred and ninety patients satisfied the inclusion criteria. MTX was terminated in 272 patients (34.4%). Toxicity‐related discontinuation occurred in 93 patients (11.8%) and due to non‐adverse reactions in 179 patients. The median duration of therapy in these two groups was 2.0 and 2.9 years, respectively. There was no difference in the average maximum weekly dose of MTX. Of patients with RA, 47.5% were in remission at last follow up. Cox proportional hazards analyses showed that those of the female sex remained on treatment significantly longer than the male sex (hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.57–0.96; P = 0.014); patients with RA remained on treatment significantly longer than patients with seronegative arthritis (HR 0.56, 95%CI 0.42–0.74; P < 0.001). Being of the male sex aged more than 60 years and having a non‐RA diagnosis predisposed to stopping MTX earlier. Conclusion: MTX is a safe and effective medication. Notable remission rates are achievable in patients with RA with current conventional treatment protocols. MTX has a low toxicity profile and this study stresses the need to re‐evaluate and revise the current monitoring guidelines.</div></front></TEI><affiliations><list><country><li>Australie</li></country><region><li>Nouvelle-Galles du Sud</li></region><settlement><li>Sydney</li></settlement><orgName><li>Université de Sydney</li></orgName></list><tree><noCountry><name sortKey="Anandacoomarasamy, A" sort="Anandacoomarasamy, A" uniqKey="Anandacoomarasamy A" first="A." last="Anandacoomarasamy">A. Anandacoomarasamy</name><name sortKey="Lim, I G S" sort="Lim, I G S" uniqKey="Lim I" first="I. G. S." last="Lim">I. G. S. Lim</name><name sortKey="Manolios, N" sort="Manolios, N" uniqKey="Manolios N" first="N." last="Manolios">N. Manolios</name><name sortKey="Russo, R" sort="Russo, R" uniqKey="Russo R" first="R." last="Russo">R. Russo</name><name sortKey="Spencer, D G" sort="Spencer, D G" uniqKey="Spencer D" first="D. G." last="Spencer">D. G. Spencer</name></noCountry><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Varatharajan, N" sort="Varatharajan, N" uniqKey="Varatharajan N" first="N." last="Varatharajan">N. Varatharajan</name></region><name sortKey="Byth, K" sort="Byth, K" uniqKey="Byth K" first="K." last="Byth">K. Byth</name><name sortKey="Howe, G B" sort="Howe, G B" uniqKey="Howe G" first="G. B." last="Howe">G. B. Howe</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Sante/explor/ChloroquineV1/Data/Main/Exploration
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 001848 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd -nk 001848 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Sante
|area= ChloroquineV1
|flux= Main
|étape= Exploration
|type= RBID
|clé= ISTEX:DF968489323B8F50B2C2CE2BC06D1B88F325FBCE
|texte= Methotrexate: long‐term safety and efficacy in an Australian consultant rheumatology practice
}}
| This area was generated with Dilib version V0.6.33. |  |