Monitoring patients taking methotrexate for hepatotoxicity. Does the standard of care match published guidelines?
BACKGROUND
Controversy persists regarding the validity of published guidelines for the monitoring of methotrexate-induced hepatotoxicity.


OBJECTIVE
The purpose of our study was to assess the standard of care by gastroenterologists in the monitoring of methotrexate-induced hepatotoxicity and to compare this standard of care with guidelines in the medical literature.


METHODS
Gastroenterologists in Connecticut and Massachusetts were surveyed by a mail-in questionnaire that inquired about their protocol for the monitoring of hepatotoxicity in patients taking methotrexate.


RESULTS
Gastroenterologists in Connecticut and Massachusetts generally follow the guidelines in the medical literature. Variation in recommendations from the rheumatologic and the dermatologic literature is reflected in the practice habits of gastroenterologists whose patients are restricted to one particular population.


CONCLUSIONS
Long-term follow-up studies should be continued to obtain further data from which to make future recommendations, especially with regard to the effects of large cumulative doses of methotrexate.
Petrazzuoli
M
M
Department of Medicine, University of Connecticut School of Medicine, Farmington.
Rothe
M J
MJ
Grin-Jorgensen
C
C
Ramsey
W H
WH
Grant-Kels
J M
JM
D000410:Alanine Transaminase / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury; D002985:Clinical Protocols; D003237:Connecticut; D016903:Drug Monitoring; D005500:Follow-Up Studies; D005762:Gastroenterology; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000201:enzymology / Q000473:pathology; D008107:Liver Diseases / Q000201:enzymology / Q000473:pathology; D008404:Massachusetts; D008727:Methotrexate / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D011565:Psoriasis / Q000188:drug therapy; D012017:Referral and Consultation
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D008727:Methotrexate