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Persistently normal blood tests in patients taking methotrexate for RA or azathioprine for IBD: a retrospective cohort study.
Fraser, Simon Ds; Lin, Sharon X; Stammers, Matthew; Culliford, David; Ibrahim, Kinda; Barrett, Ravina; Howard, Clare; Johnson, Ruth; Barnes, Nicola; Batchelor, James; Holroyd, Christopher; Adams, Jo; Rischin, Adam; Roderick, Paul; Rutter, Paul; Edwards, Christopher J.
  • Fraser SD; School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
  • Lin SX; Southampton General Hospital, Southampton, UK.
  • Stammers M; University Hospital Southampton NHS Foundation Trust, Southampton, UK.
  • Culliford D; National Institute for Health Research Applied Research Collaboration Wessex, School of Health Sciences, University of Southampton, Southampton, UK.
  • Ibrahim K; Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.
  • Barrett R; School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK.
  • Howard C; Wessex Academic Health Science Network, Chilworth, UK.
  • Johnson R; Commissioning Support Unit, NHS South, Central and West, Eastleigh, UK.
  • Barnes N; School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.
  • Batchelor J; Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
  • Holroyd C; University Hospital Southampton NHS Foundation Trust, Southampton, UK.
  • Adams J; School of Health Sciences, University of Southampton, Southampton, UK.
  • Rischin A; Alfred Health, Melbourne, Australia.
  • Roderick P; School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
  • Rutter P; School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.
  • Edwards CJ; Clinical Rheumatology, University of Southampton, Southampton, UK.
Br J Gen Pract ; 72(720): e528-e537, 2022 07.
Article en En | MEDLINE | ID: mdl-35256384
ABSTRACT

BACKGROUND:

Disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate and azathioprine, are commonly used to treat rheumatoid arthritis (RA) and inflammatory bowel disease (IBD). Blood-test safety monitoring is mainly undertaken in primary care. Normal blood results are common.

AIM:

To determine the frequency and associations of persistently normal blood tests in patients with RA prescribed methotrexate, and patients with IBD prescribed azathioprine. DESIGN AND

SETTING:

Two-year retrospective study of a cohort taken from an electronic pseudonymised primary care/laboratory database covering >1.4 million patients across Hampshire, UK.

METHOD:

Patients with RA and IBD, and associated methotrexate and azathioprine prescriptions, respectively, were identified. Tests and test thresholds recommended by the National Institute for Health and Care Excellence were applied. Persistent normality was defined as no abnormalities of any tests nor alanine aminotransferase (ALT), white blood count (WBC), neutrophils, and estimated glomerular filtration rate (eGFR) individually. Logistic regression was used to identify associations with test normality.

RESULTS:

Of 702 265 adults, 7102 had RA and 8597 had IBD. In total, 3001 (42.3%) patients with RA were prescribed methotrexate and 1162 (13.5%) patients with IBD were prescribed azathioprine; persistently normal tests occurred in 1585 (52.8%) and 657 (56.5%) of the populations, respectively. In patients with RA on methotrexate, 585 (19.5%) had eGFR, 219 (7.3%) ALT, 217 (7.2%) WBC, and 202 (6.7%) neutrophil abnormalities. In patients with IBD on azathioprine, 138 (11.9%) had WBC, 88 (7.6%) eGFR, 72 (6.2%) ALT, and 65 (5.6%) neutrophil abnormalities. Those least likely to have persistent test normality were older and/or had comorbidities.

CONCLUSION:

Persistent test normality is common when monitoring these DMARDs, with few hepatic or haematological abnormalities. More stratified monitoring approaches should be explored.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Artritis Reumatoide / Enfermedades Inflamatorias del Intestino / Antirreumáticos Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Año: 2022 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Artritis Reumatoide / Enfermedades Inflamatorias del Intestino / Antirreumáticos Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Año: 2022 Tipo del documento: Article