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Patientensicherheit in der Rheumatherapie: Labormonitoring bei Methotrexat
BACKGROUND: Methotrexate (MTX) is the most commonly prescribed disease-modifying drug in the treatment of rheumatic diseases. Regular laboratory testing is recommended to recognize side effects, such as hepatotoxicity and myelotoxicity as well as decreases in renal function that may cause toxic MTX...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Medizin
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189943/ https://www.ncbi.nlm.nih.gov/pubmed/33709166 http://dx.doi.org/10.1007/s00393-021-00976-7 |
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author | Sierocinski, Elizabeth Angelow, Aniela Mainz, Armin Walker, Jochen Chenot, Jean-François |
author_facet | Sierocinski, Elizabeth Angelow, Aniela Mainz, Armin Walker, Jochen Chenot, Jean-François |
author_sort | Sierocinski, Elizabeth |
collection | PubMed |
description | BACKGROUND: Methotrexate (MTX) is the most commonly prescribed disease-modifying drug in the treatment of rheumatic diseases. Regular laboratory testing is recommended to recognize side effects, such as hepatotoxicity and myelotoxicity as well as decreases in renal function that may cause toxic MTX accumulation. Additionally, folic acid is recommended as prophylaxis against specific side effects. In this study we investigated whether laboratory monitoring and prescription of folic acid took place according to published recommendations. MATERIAL AND METHODS: Claims data from the statutory health insurance from 1 January 2009 to 31 December 2013 were retrospectively analyzed. A total of 40,087 adults with a rheumatic diagnosis (ICD10 codes M05–M18), no malignant disease and no previous MTX prescription within 12 months were extracted from the InGef (Institute for Applied Health Research in Berlin, formerly Health Risk Institute) research database. The frequency of recommended laboratory testing, appointments with rheumatologists and the prescription of folic acid prophylaxis were investigated. RESULTS: Of the patients 12,451 began treatment with MTX in the observation period. Between 42% and 46% of recommended blood counts, liver values and kidney function tests and 14% of urinalyses were performed according to recommendations. Of the patients 84% were seen regularly by a rheumatologist and 74% received a prescription for prophylactic folic acid. Serious conditions potentially resulting from MTX treatment were observed in 0.7–3.5 cases/1000 person years. DISCUSSION: Laboratory monitoring in the context of MTX treatment is carried out less frequently than recommended in the literature. Potential MTX-associated serious complications are rare from a practice perspective. On the one hand solutions are needed for a better coordination of laboratory monitoring. On the other hand more empirical evidence is needed regarding the benefits of laboratory monitoring and the appropriate intervals thereof. |
format | Online Article Text |
id | pubmed-8189943 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Medizin |
record_format | MEDLINE/PubMed |
spelling | pubmed-81899432021-06-28 Patientensicherheit in der Rheumatherapie: Labormonitoring bei Methotrexat Sierocinski, Elizabeth Angelow, Aniela Mainz, Armin Walker, Jochen Chenot, Jean-François Z Rheumatol Originalien BACKGROUND: Methotrexate (MTX) is the most commonly prescribed disease-modifying drug in the treatment of rheumatic diseases. Regular laboratory testing is recommended to recognize side effects, such as hepatotoxicity and myelotoxicity as well as decreases in renal function that may cause toxic MTX accumulation. Additionally, folic acid is recommended as prophylaxis against specific side effects. In this study we investigated whether laboratory monitoring and prescription of folic acid took place according to published recommendations. MATERIAL AND METHODS: Claims data from the statutory health insurance from 1 January 2009 to 31 December 2013 were retrospectively analyzed. A total of 40,087 adults with a rheumatic diagnosis (ICD10 codes M05–M18), no malignant disease and no previous MTX prescription within 12 months were extracted from the InGef (Institute for Applied Health Research in Berlin, formerly Health Risk Institute) research database. The frequency of recommended laboratory testing, appointments with rheumatologists and the prescription of folic acid prophylaxis were investigated. RESULTS: Of the patients 12,451 began treatment with MTX in the observation period. Between 42% and 46% of recommended blood counts, liver values and kidney function tests and 14% of urinalyses were performed according to recommendations. Of the patients 84% were seen regularly by a rheumatologist and 74% received a prescription for prophylactic folic acid. Serious conditions potentially resulting from MTX treatment were observed in 0.7–3.5 cases/1000 person years. DISCUSSION: Laboratory monitoring in the context of MTX treatment is carried out less frequently than recommended in the literature. Potential MTX-associated serious complications are rare from a practice perspective. On the one hand solutions are needed for a better coordination of laboratory monitoring. On the other hand more empirical evidence is needed regarding the benefits of laboratory monitoring and the appropriate intervals thereof. Springer Medizin 2021-03-11 2021 /pmc/articles/PMC8189943/ /pubmed/33709166 http://dx.doi.org/10.1007/s00393-021-00976-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden. Die in diesem Artikel enthaltenen Bilder und sonstiges Drittmaterial unterliegen ebenfalls der genannten Creative Commons Lizenz, sofern sich aus der Abbildungslegende nichts anderes ergibt. Sofern das betreffende Material nicht unter der genannten Creative Commons Lizenz steht und die betreffende Handlung nicht nach gesetzlichen Vorschriften erlaubt ist, ist für die oben aufgeführten Weiterverwendungen des Materials die Einwilligung des jeweiligen Rechteinhabers einzuholen. Weitere Details zur Lizenz entnehmen Sie bitte der Lizenzinformation auf http://creativecommons.org/licenses/by/4.0/deed.de (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Originalien Sierocinski, Elizabeth Angelow, Aniela Mainz, Armin Walker, Jochen Chenot, Jean-François Patientensicherheit in der Rheumatherapie: Labormonitoring bei Methotrexat |
title | Patientensicherheit in der Rheumatherapie: Labormonitoring bei Methotrexat |
title_full | Patientensicherheit in der Rheumatherapie: Labormonitoring bei Methotrexat |
title_fullStr | Patientensicherheit in der Rheumatherapie: Labormonitoring bei Methotrexat |
title_full_unstemmed | Patientensicherheit in der Rheumatherapie: Labormonitoring bei Methotrexat |
title_short | Patientensicherheit in der Rheumatherapie: Labormonitoring bei Methotrexat |
title_sort | patientensicherheit in der rheumatherapie: labormonitoring bei methotrexat |
topic | Originalien |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189943/ https://www.ncbi.nlm.nih.gov/pubmed/33709166 http://dx.doi.org/10.1007/s00393-021-00976-7 |
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