Busger op Vollenbroek, F. (Felien) (2015) Laboratoriumcontroles bij methotrexaatgebruik: dermatologie versus reumatologie. thesis, Medicine.
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Abstract
Introduction: Current guidelines for monitoring side effects during methotrexate (MTX) usage are dissimilar for patients with psoriasis and patients with psoriatic arthritis (PsA) or rheumatoid arthritis (RA). To prevent hepatotoxicity, infections or bleeding due to MTX, laboratory monitoring is needed. However, drug survival could be decreased due to intensive monitoring. Patients might discontinue MTX unnecessary and might make an early change to treatments based on pricey biologicals. On the contrary, less monitoring might lead to more severe side effects due to MTX. Aims: Determine whether the monitoring guideline for MTX used by dermatologists is too intensive and as a result of this, drug survival is limited; Determine whether the MTX guideline used by rheumatologists is too limited and as a result of this, serious adverse events appear more often. Materials & Methods: We performed a retrospective cohort study based on three different cohorts. Data was collected out of digital medical files from 181 psoriasis patients. These were compared to collected data from 165 PsA and 392 RA patients. These patients all have started using MTX in the period between 2006 and 2012. The follow-up period ended by discontinuation of MTX. For patients who still used MTX in December 2014, a stop date was registered equal to the date of their last policlinic appointment. Drug survival, laboratory abnormalities, complications and reasons for discontinuation were examined and statistically analyzed. For statistical analysis, Kaplan-Meier analysis, chi-square tests and Fisher’s exact tests were used, among others. Results: We found an average drug survival of 19 months for patients with psoriasis. Average drug survival for PsA and RA patients were significantly higher, respectively 31 and 39 months. 33% of the laboratory test moments were abnormal in the psoriasis cohort, com-pared to resp. 17% and 11% in the PsA and RA cohort. The incidence of ALT (40-45%), leukocyte (3-7%) and platelet (2-4%) abnormalities were similar in all cohorts. The majority of the leukocyte and platelet abnormalities were mild. Complementary laboratory tests for psoriasis patients (AST, ALP and γ-GT) were rarely (15 cases) responsible for dosage changes or discontinuation of MTX. Furthermore, in resp. 89%, 69% en 67% of the AST-, ALP or γ-GT abnormalities, the ALT test was abnormal too. Laboratory abnormalities were more often reason for discontinuation of MTX in the psoriasis cohort compared to the rheumatology cohorts. Conclusion: The intensive monitoring strategy used by dermatologists, leads to more abnormal laboratory test moments and to a decrease in drug survival in psoriatic patients. The less intensive monitoring strategy used by rheumatologists, does not lead to the occurrence of more serious adverse events in psoriatic arthritis and rheumatoid arthritis patients. The results of this study do not support the intensive monitoring strategy used by dermatologists.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Bernelot Moens, Dr. H.J. |
| Supervisor name: | Janssens, Dr. R.W.A. and Ziekenhuisgroep Twente |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/630 |
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