Methotrexate intolerance in rheumatoid arthritis Save
A current large rheumatoid arthritis (RA) cohort study from Cairo assessed methotrexate (MTX) use and found over half were MTX intolerant and a third of patients were noncompliant with MTX.
A total of 355 RA patients on MTX for at least three months were included and assessed using the MTX Intolerance Severity Score (MISS). Drug compliance assessed using the 5-Item Compliance Questionnaire for Rheumatology (CQR5).
Over half of the MTX treated RA population (50.7%) were MTX intolerant, and only two-thirds (66.2%) were compliant on MTX. Predictors of MTX intolerance Included:
- Younger age at disease onset (p = 0.006)
- Longer disease duration (p = 0.001)
- Parenteral MTX administration (IM/oral p < 0.001, OR 3.95, SC/oral p < 0.001, OR 7.73)
- fixed morning dosing compared to divided or inconsistent schedule divided/morning p < 0.001, Inconsistent time/morning p = 0.014)
- Receiving MTX before meals versus after meals (p = 0.007, OR 5.61)
- Concomitant leflunomide use (p = 0.01, OR 1.88)
- Higher tender joint count (p = 0.03)
- Leflunomide intake (p = 0.002, OR 2.65) and parenteral MTX administration (IM/oral 0.002, OR 6.06, SC/oral < 0.001, OR 14.3) were the only predictors in multivariate logistic regression.
- Less tobacco: number of cigarette pack/year (p = 0.007).
Caffeine intake, folate adherence/dosage, disease activity, and extra-articular manifestations were not associated with MTX intolerance.
MTX intolerance and noncompliance is common. More so with parenteral use, combined use with LEF and possibly in women.
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The author has no conflicts of interest to disclose related to this subject
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