Methotrexate: prescribing and monitoring practices among the consultant membership of the British Association of Dermatologists

被引:12
作者
Collin, B. [1 ]
Srinathan, S. K. [1 ]
Finch, T. M. [1 ]
机构
[1] Solihull Hosp, Dept Dermatol, Solihull B91 2JL, W Midlands, England
关键词
guidelines; liver biopsy; methotrexate; monitoring; prescribing;
D O I
10.1111/j.1365-2133.2007.08426.x
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Background Methotrexate is frequently used in dermatology practice and is potentially toxic. Prescribing and monitoring strategies have evolved over time and many areas of practice remain controversial and without firm evidence base. Objectives To document current U.K. prescribing and monitoring practice and to identify variations in practice. Methods A postal questionnaire was sent, in a single mailshot, in January 2004 to the entire consultant membership (n = 531) of the British Association of Dermatologists. Results We received a response rate of 71%. The majority of respondents prescribed for small numbers of patients and 81% reported using a patient information sheet. Almost all monitored full blood count, liver function tests and urea, electrolytes and creatinine, and 71% measured aminoterminal peptide of type III procollagen levels. We identified a wide range of practice in the use of liver biopsy. In terms of adverse events, 12% reported experience of patients developing irreversible liver damage (severity not defined). Forty-nine deaths were reported, of which 18 were due to myelosuppression, six to possible pulmonary fibrosis, two to liver failure in the absence of reported alcohol consumption and four as a consequence of liver biopsy. Conclusions We have documented wide variations in methotrexate prescribing and monitoring practice. We compare reported practice with current guidelines and highlight the importance of monitoring for myelosuppression.
引用
收藏
页码:793 / 800
页数:8
相关论文
共 38 条
[31]   Methotrexate hepatotoxicity [J].
West, SG .
RHEUMATIC DISEASE CLINICS OF NORTH AMERICA, 1997, 23 (04) :883-&
[32]   Folate supplementation and methotrexate treatment in rheumatoid arthritis: a review [J].
Whittle, SL ;
Hughes, RA .
RHEUMATOLOGY, 2004, 43 (03) :267-271
[33]   MONITORING FOR ADVERSE-EFFECTS FROM SYSTEMIC DRUGS USED IN DERMATOLOGY [J].
WOLVERTON, SE .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 1992, 26 (05) :661-679
[34]   Have methotrexate-induced liver fibrosis and cirrhosis become rare? A matter for reappraisal of routine liver biopsies [J].
Zachariae, H .
DERMATOLOGY, 2005, 211 (04) :307-308
[35]  
ZACHARIAE H, 1989, ACTA DERM-VENEREOL, V69, P241
[36]   The value of amino-terminal propeptide of type III procollagen in routine screening for methotrexate-induced liver fibrosis: a 10-year follow-up [J].
Zachariae, H ;
Heickendorff, L ;
Sogaard, H .
BRITISH JOURNAL OF DERMATOLOGY, 2001, 144 (01) :100-103
[37]   Methotrexate-induced liver cirrhosis - Clinical, histological and serological studies - A further 10-year follow-up [J].
Zachariae, H ;
Sogaard, H ;
Heickendorff, L .
DERMATOLOGY, 1996, 192 (04) :343-346
[38]   SERUM AMINOTERMINAL PROPEPTIDE OF TYPE-III PROCOLLAGEN IN PSORIASIS AND PSORIATIC-ARTHRITIS - RELATION TO LIVER FIBROSIS AND ARTHRITIS [J].
ZACHARIAE, H ;
ASLAM, HM ;
BJERRING, P ;
SOGAARD, H ;
ZACHARIAE, E ;
HEICKENDORFF, L .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 1991, 25 (01) :50-53