Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long‐term follow‐up of predictors, surveillance, and outcome in clinical practice
Luleå University of Technology, Department of Health Sciences, Medical Science. Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Clinical Pharmacology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Clinical Pharmacology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
Luleå University of Technology, Department of Engineering Sciences and Mathematics, Material Science. Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.ORCID iD: 0000-0002-1655-6658
Show others and affiliations
2019 (English)In: International Journal of Rheumatic Diseases, E-ISSN 1756-185X, Vol. 22, no 7, p. 1226-1232Article in journal (Refereed) Published
Abstract [en]

Aim

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.

Methods

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.

Results

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%, P = 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.

Conclusion

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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019. Vol. 22, no 7, p. 1226-1232
Keywords [en]
liver toxicity, liver transaminases, methotrexate, non‐alcoholic fatty liver disease, rheumatoid arthritis
National Category
Other Health Sciences Other Physics Topics
Research subject
Health Science; Applied Physics
Identifiers
URN: urn:nbn:se:ltu:diva-73727DOI: 10.1111/1756-185X.13576ISI: 000476560400008PubMedID: 31012257OAI: oai:DiVA.org:ltu-73727DiVA, id: diva2:1306417
Note

Validerad;2019;Nivå 2;2019-08-19 (johcin)

Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-08-19Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records BETA

Sundbaum, JohannaLehto, Niklas

Search in DiVA

By author/editor
Sundbaum, JohannaLehto, Niklas
By organisation
Medical ScienceMaterial Science
Other Health SciencesOther Physics Topics

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 55 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf