TY - JOUR
T1 - Measuring transaminases in patients with rheumatoid arthritis on weekly methotrexate
T2 - does timing of blood testing matter?
AU - Mecoli, Christopher A.
AU - Delev, Nikolay G.
AU - Bingham, Clifton O.
N1 - Funding Information:
This work was supported by The Johns Hopkins Arthritis Center Discovery Fund. This study was also supported in part by Grant Number P30-AR053503 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Research reported in this publication was also supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number T32AR048522. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIAMS or the National Institutes of Health.
Publisher Copyright:
© 2016, International League of Associations for Rheumatology (ILAR).
PY - 2016/12/1
Y1 - 2016/12/1
N2 - The change in transaminase levels over a single week during therapy with methotrexate (MTX) has not been investigated or reported to date. In clinical practice, it is common to observe abnormal transaminase levels upon routine blood work for toxicity monitoring. Many have suggested that such lab abnormalities can sometimes be attributed to sampling blood for toxicity monitoring proximately following MTX dosing. The aim of our study was to evaluate changes in transaminase levels (AST/ALT) over 1 week after MTX administration in rheumatoid arthritis (RA) patients. In this small proof of concept study, we evaluated 13 patients with RA taking stable doses of methotrexate and background medications (e.g., NSAIDs and prednisone), but no other disease-modifying anti-rheumatic drugs (DMARDs). All patients were on a stable dose of folic acid. Patients received their usual doses of MTX administered at a specified time, and then sequential blood samples were obtained over the course of 7 days. Peripheral blood was obtained at each time point to measure serum transaminases. We did not observe any significant change in sequential transaminases over 1 week in relationship to MTX administration. It is possible that MTX therapy alone does not lead to significant weekly transaminase variations, contrary to our clinical expectations. The addition of other medications (i.e., NSAIDs) to stable MTX regimen may result in transaminase abnormalities.
AB - The change in transaminase levels over a single week during therapy with methotrexate (MTX) has not been investigated or reported to date. In clinical practice, it is common to observe abnormal transaminase levels upon routine blood work for toxicity monitoring. Many have suggested that such lab abnormalities can sometimes be attributed to sampling blood for toxicity monitoring proximately following MTX dosing. The aim of our study was to evaluate changes in transaminase levels (AST/ALT) over 1 week after MTX administration in rheumatoid arthritis (RA) patients. In this small proof of concept study, we evaluated 13 patients with RA taking stable doses of methotrexate and background medications (e.g., NSAIDs and prednisone), but no other disease-modifying anti-rheumatic drugs (DMARDs). All patients were on a stable dose of folic acid. Patients received their usual doses of MTX administered at a specified time, and then sequential blood samples were obtained over the course of 7 days. Peripheral blood was obtained at each time point to measure serum transaminases. We did not observe any significant change in sequential transaminases over 1 week in relationship to MTX administration. It is possible that MTX therapy alone does not lead to significant weekly transaminase variations, contrary to our clinical expectations. The addition of other medications (i.e., NSAIDs) to stable MTX regimen may result in transaminase abnormalities.
KW - Methotrexate
KW - Pharmacology
KW - Rheumatoid arthritis
KW - Transaminases
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U2 - 10.1007/s10067-016-3361-3
DO - 10.1007/s10067-016-3361-3
M3 - Article
C2 - 27473088
AN - SCOPUS:84980016047
SN - 0770-3198
VL - 35
SP - 3053
EP - 3056
JO - Clinical rheumatology
JF - Clinical rheumatology
IS - 12
ER -