RESEARCH - Risk factors for MTX-induced abnormal laboratory results in patients with RA

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J Rheumatol. 2004 Sep;31(9):1727-31.

Risk factors for methotrexate-induced abnormal laboratory monitoring

results in patients with rheumatoid arthritis.

Kent PD, Luthra HS, Michet C Jr.

Division of Rheumatology and Internal Medicine, Mayo Clinic, Rochester,

Minnesota, USA.

OBJECTIVE: To determine risk factors for methotrexate (MTX)-induced

hepatic and hematologic laboratory abnormalities in patients with

rheumatoid arthritis (RA). METHODS: Measurements of aspartate

aminotransferase (AST), white blood cell counts, and platelet counts

were collected in a database of patients with RA receiving MTX from 1991

through 2002. Potential risk factors for toxicity were recorded on each

patient. RESULTS: Four hundred and eighty-one patients were followed for

2,323 person-years of MTX exposure. MTX was discontinued permanently

because of abnormal laboratory test results in 22 patients (4.6%), the

majority of whom (17/22, 77%) had elevated AST values. The body mass

index (BMI) was significantly higher in those patients where MTX was

permanently discontinued than in those in whom it was not (p < 0.03).

Independent predictors of a significantly higher percentage of abnormal

AST values were lack of folate supplementation (p < 0.001) and untreated

hyperlipidemia (p < 0.02). Of the 17 patients in whom MTX was

discontinued permanently because of an elevated AST value, 11/17 (65%)

had either lack of folate supplementation or untreated hyperlipidemia.

Hypoalbuminemia correlated independently with an increased percentage of

abnormal platelet counts (p < 0.03).

CONCLUSION: Lack of folate supplementation, untreated hyperlipidemia,

and elevated BMI identified patients receiving MTX at risk for

transaminase elevation, and low serum albumin was a risk factor for

thrombocytopenia. Nonalcoholic fatty liver disease could be the

underlying risk factor for transaminase elevation in patients with

hyperlipidemia and obesity.

PMID: 15338491

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5338491 & dopt=Abstract

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Mayo Clinic in Rochester

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s Hopkins Medicine

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