Methotrexate and histologic hepatic abnormalities: a meta-analysis
Article Abstract:
Among its other uses, the drug methotrexate has been used to treat rheumatoid arthritis and psoriasis, a skin disorder. It is no longer used to treat arthritis because the doses needed for treatment can result in severe liver damage. Low levels of the drug are still used to treat psoriasis, and evidence suggests low levels might also be useful in treating arthritis. A few studies examined the effects of low dosages on the liver, and data were obtained from liver biopsies, but none of the studies was large enough for any conclusions to be drawn. This study utilized a statistical technique known as meta-analysis to evaluate the combined data from these previous studies, to determine whether any relationship between low levels of methotrexate and liver abnormalities could be found. Data were obtained found for 636 patients involved in 15 studies, of whom 334 had rheumatoid arthritis and 299 had psoriasis. Average therapy times for all patients was 210.5 weeks, with an average cumulative dose of 2,536 mg. Liver tissue biopsies revealed progression of liver damage in 178 (28 percent) of the patients, of whom 26.3 percent were light alcohol consumers and 73.3 percent were heavy alcohol consumers. Analysis of drug therapy and progression of liver cell damage found that progression was related to total cumulative dose of methotrexate. There was a 6.7 percent risk of progressing one histologic stage (i.e. a measurable degree of damage) per 1,000 mg of methotrexate consumed. These results indicate that long-term, low-dosage therapy with methotrexate poses a significant risk for liver damage, particularly in heavy drinkers. Such therapy should not be used for heavy drinkers, and regular liver biopsies should be performed in patients being given methotrexate for treatment of rheumatoid arthritis or psoriasis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Weekly subcutaneous recombinant human erythropoietin corrects anemia of progressive renal failure
Article Abstract:
The kidney is important not only for adjusting salt and water balance, but also for its synthesis of erythropoietin, a hormone that stimulates red blood cell production. Anemia is commonly found in patients with failing kidneys and can be attributed to decreased erythropoietin production. Technology has allowed laboratory and factory production of the human form of the hormone, and this recombinant human erythropoietin (rHuEPO) can correct anemia in dialysis patients when given intravenously three times a week, usually with dialysis treatments. Some patients with progressive kidney failure can receive a form of dialysis at home. For them, travel to receive intravenous treatment can be inconvenient, and so the effect of rHuEPO administered under the skin was evaluated in seven patients receiving home peritoneal dialysis and in 12 patients with progressive kidney failure and anemia who were not yet receiving dialysis. Anemia improvement was indicated by increases in hematocrit (proportion of blood volume occupied by blood cells), with a hematocrit of 31 percent the target level, below which patients would be at risk for transfusion in the event of a hemorrhage or infection. Hematocrits greater than 31 percent were achieved by all but three patients. Some required weekly injections for 3 to 12 weeks before this was achieved, while others received injections two to three times weekly before reaching the target hematocrit. Hematocrit was maintained with weekly injections of 4,000 to 10,000 Units of the protein. The study indicates that weekly administration of rHuEPO is effective in correcting anemia associated with kidney failure. This type of protocol is convenient for many patients and is cost-effective for the Medicare system. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Herpes zoster in patients with rheumatoid arthritis treated with weekly, low-dose methotrexate
Article Abstract:
Rheumatoid arthritis (RA) is a joint disease characterized by inflammation of the joints, stiffness, swelling, overgrowth of cartilage tissue, and pain. The drug methotrexate is used to treat RA and is given orally in low doses. However, treatment with methotrexate has been associated with the development of herpes zoster (shingles), an acute infectious disease caused by the varicella-zoster virus. The frequency of herpes zoster was assessed in 187 patients with RA who were being treated with methotrexate. The frequency of herpes zoster was 14.5 cases per 1,000 patient-years in this group of methotrexate-treated RA patients. This rate is higher than the incidence of herpes zoster in the general population, which is 1.3 to 4.8 cases per 1,000 patient-years. The infection was not related to: duration of methotrexate treatment; the need for prednisone, a steroid agent; or coexisting diabetes mellitus. A greater frequency of herpes zoster was associated with higher levels of rheumatoid factor, an immune protein present in the blood of 50 to 95 percent of patients with RA, and longer duration of RA. Herpes zoster did not spread or recur in any case of methotrexate-treated RA. These findings show that herpes zoster occurs with greater frequency in methotrexate-treated RA patients than in the general population. However, the infection tends to resolve spontaneously and is benign. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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