Muhammad Sohaib Asghar1, Karan Kumar2, Sadia Iqbal1, Om Parkash3, Sumeet Kumar2, Manjeet Singh4, Rumael Jawed4, Mohammed Akram4, Farah Yasmin1, Muhammad J Tahir5, Zohaib Yousaf6. 1. Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan. 2. Department of Internal Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan. 3. Department of Internal Medicine, Chandka Medical College, Larkana, Pakistan. 4. Department of Internal Medicine, Liaquat National Hospital & Medical College, Karachi, Pakistan. 5. Department of Internal Medicine, Lahore General Hospital, Lahore, Pakistan. 6. Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
Abstract
Background and objectives: Methotrexate (MTX) is globally used by physicians to treat patients with Rheumatoid Arthritis (RA). Previously conducted researches indicate prevalent side effects associated with conventional once-weekly dosage amongst a population sample of patients consuming MTX. The objectives of our study were to find out whether there is a difference between the two studied regimens in efficacy and adverse effects of methotrexate. Materials and methods: Study participants were recruited from the outpatient rheumatology department after ethical approval and informed patient consent. Disease activity was assessed at baseline with various reliable and validated scales (SDAI, PAS, DAS-28 among others) after the propensity score-matched 1:1 among the two groups. One group continued their once-weekly regimen (group A), while the other group had their dosage of oral MTX split into alternate days per week (group B). The propensity-matched groups of 123 patients each were included in the final analysis. Results: The most frequently reported side effect was decreased appetite, followed by gastritis, nausea, headache, and vomiting. Within the two groups, no significant differences were found in disease activity scales. The only considerable difference was mean corpuscular volume (MCV) being higher in Group A (p = 0.0128). Comparison of side effect profile at 6 months after intervention showed improved gastritis (63.4 vs 41.5%), nausea (51.2% vs 35.8%), appetite (74.0% vs 60.2%) and hepatotoxicity (14.6% vs 5.7%) in Group B. Conclusion: An alternate-day regimen may prove more beneficial to the patient's compliance due to fewer side effects and similar efficacy to the conventional dosage.
Background and objectives: Methotrexate (MTX) is globally used by physicians to treat patients with Rheumatoid Arthritis (RA). Previously conducted researches indicate prevalent side effects associated with conventional once-weekly dosage amongst a population sample of patients consuming MTX. The objectives of our study were to find out whether there is a difference between the two studied regimens in efficacy and adverse effects of methotrexate. Materials and methods: Study participants were recruited from the outpatient rheumatology department after ethical approval and informed patient consent. Disease activity was assessed at baseline with various reliable and validated scales (SDAI, PAS, DAS-28 among others) after the propensity score-matched 1:1 among the two groups. One group continued their once-weekly regimen (group A), while the other group had their dosage of oral MTX split into alternate days per week (group B). The propensity-matched groups of 123 patients each were included in the final analysis. Results: The most frequently reported side effect was decreased appetite, followed by gastritis, nausea, headache, and vomiting. Within the two groups, no significant differences were found in disease activity scales. The only considerable difference was mean corpuscular volume (MCV) being higher in Group A (p = 0.0128). Comparison of side effect profile at 6 months after intervention showed improved gastritis (63.4 vs 41.5%), nausea (51.2% vs 35.8%), appetite (74.0% vs 60.2%) and hepatotoxicity (14.6% vs 5.7%) in Group B. Conclusion: An alternate-day regimen may prove more beneficial to the patient's compliance due to fewer side effects and similar efficacy to the conventional dosage.
Authors: D M van der Heijde; M A van 't Hof; P L van Riel; L A Theunisse; E W Lubberts; M A van Leeuwen; M H van Rijswijk; L B van de Putte Journal: Ann Rheum Dis Date: 1990-11 Impact factor: 19.103
Authors: Daniel Aletaha; Tuhina Neogi; Alan J Silman; Julia Funovits; David T Felson; Clifton O Bingham; Neal S Birnbaum; Gerd R Burmester; Vivian P Bykerk; Marc D Cohen; Bernard Combe; Karen H Costenbader; Maxime Dougados; Paul Emery; Gianfranco Ferraccioli; Johanna M W Hazes; Kathryn Hobbs; Tom W J Huizinga; Arthur Kavanaugh; Jonathan Kay; Tore K Kvien; Timothy Laing; Philip Mease; Henri A Ménard; Larry W Moreland; Raymond L Naden; Theodore Pincus; Josef S Smolen; Ewa Stanislawska-Biernat; Deborah Symmons; Paul P Tak; Katherine S Upchurch; Jirí Vencovský; Frederick Wolfe; Gillian Hawker Journal: Arthritis Rheum Date: 2010-09
Authors: J S Smolen; F C Breedveld; M H Schiff; J R Kalden; P Emery; G Eberl; P L van Riel; P Tugwell Journal: Rheumatology (Oxford) Date: 2003-02 Impact factor: 7.580