Predictors of methotrexate-related adverse events described in RA patients
medwireNews: Research presented at the online British Society for Rheumatology 2021 Annual Conference has identified predictors of adverse events (AEs) in people with rheumatoid arthritis (RA) receiving treatment with methotrexate.
Ahmad Sherbini (University of Manchester, UK) told delegates that AEs “are a common reason for nonadherence” to methotrexate, and “a considerable number” of RA patients discontinue the drug due to AEs.
The study included 1069 patients (65% women) with a mean age of 59 years who initiated methotrexate at one of 38 centers across the UK. Approximately half of the patients had a methotrexate starting dose of at least 15 mg/week.
During the first year of treatment, the most frequently occurring AEs were gastrointestinal, affecting 41% of patients. Sherbini reported that female sex and a higher concern score on the Beliefs about Medicines Questionnaire were significantly associated with a higher risk for gastrointestinal AEs, while older age was associated with a significantly lower risk.
Women also had a significantly higher risk for neurologic (headache, dizziness, blurred vision, or hearing loss) and mucocutaneous (alopecia, itching, rash, or oral ulcers) AEs than men. Alcohol consumption was an additional significant predictor of increased risk for mucocutaneous AEs, whereas higher DAS28-CRP score and a methotrexate starting dose of at least 15 mg/week were associated with a significantly lower risk.
In contrast to these findings, women did not have a significantly elevated risk for hematologic AEs – including anemia, leucopenia, thrombocytopenia, and pancytopenia – compared with men. Alcohol consumption and older age were both associated with a reduced risk for these AEs; use of other DMARDs in addition to methotrexate was significantly associated with an increased risk for hematologic AEs but a decreased risk for liver enzyme elevations.
“Different sets of predictors were identified for each of the studied outcomes, which could indicate different pathological and psychological processes leading to the development and reporting of these adverse events,” said Sherbini.
He concluded that knowledge about predictors of methotrexate-related AEs may help “to better communicate the risk of possible AEs prior to commencing methotrexate, to identify future patients likely to experience these AEs early in the course of treatment, and to optimize methotrexate therapy by tailoring the dosing strategy or the frequency of monitoring.”
The presenter added: “All of this can lead to increased adherence and consequently improve effectiveness of the treatment.”
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