Frequency and causes of discontinuation of methotrexate in a cohort of Egyptian patients

Abstract

Aim of the workTo evaluate frequency and causes of discontinuation of methotrexate (MTX) in a group of Egyptian patients and to identify factors that may increase the incidence of its discontinuation. Patients and methodsOne hundred and fifty seven rheumatoid arthritis (RA) patients with disease duration of at least one year, using or were using methotrexate, were included in this study. All patients were subjected to full history taking including the cause of discontinuation of methotrexate, full detailed clinical examination, laboratory assessment, X-ray hands and assessment of disease activity score (28 joints) (DAS 28) for all RA patients. Patients were divided into two groups according to the current status of MTX use, to identify factors which may increase the incidence of MTX discontinuation. ResultsForty six (29.3%) of the patients stopped MTX due to different causes, hepatic and gastrointestinal side effects were the most common causes of discontinuation, representing together 69.5% of causes of discontinuation. We found significant statistical difference between the two groups regarding disease duration, erythrocyte sedimentation rate (ESR), corticosteroid and non steroidal-anti-inflammatory drug (NSAID) use. ConclusionMTX is a safe and effective drug for RA patients and usually well tolerated, however the use of NSAIDs and corticosteroid may be associated with increased risk of discontinuation of methotrexate especially in patients with long standing disease.