title: Safety of less frequent monitoring of liver transaminases levels in rheumatic patients treated with low-dose methotrexate.
abstract: OBJECTIVE
  Consideration of the safety of liver transaminases monitoring every 12 weeks in patients with inflammatory connective tissue disorders who are treated with methotrexate (MTX).
  
  
  METHODS
  In a retrospective study, the data from rheumatic patients receiving MTX were analyzed. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured every 12 weeks. Based on the physician's final decision about the continuation of MTX, the patients were classified into one of the following groups: continuation of MTX without MTX dose reduction, MTX dose reduction, MTX discontinuation due to liver complication and MTX discontinuation due to other reasons.
  
  
  RESULTS
  A total of 809 patients who were on MTX were included in the study. The mean follow-up duration and the mean duration of treatment with MTX were 31.22 and 19.76 months, respectively. The mean accumulation dose of MTX was 865.85 mg. Due to the increase in the level of transaminases in 3.2% of the patients, MTX dose was reduced; and in 1.1% of the cases it was temporarily discontinued. In the follow-up of the patients with elevated transaminases, they returned to normal limits in 99.5% of patients; and only in four cases (0.5%) they remained elevated and MTX was discontinued. The probability of the patients remaining on MTX for 5 years without discontinuation for liver complications was 98.5%
  
  
  CONCLUSIONS
  Liver transaminase monitoring every 12 weeks for MTX-treated patients is safe.
authors: Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors: Alireza
authors: A
authors: Khabbazi
authors: Sousan
authors: S
authors: Kolahi
authors: Saeed
authors: S
authors: Dastgiri
authors: Mehrzad
authors: M
authors: Hajialiloo
authors: Mahshid
authors: M
authors: Nazeri
authors: Leila
authors: L
authors: Nazeri
authors: Arefe
authors: A
authors: Sheikholeslami Salmasi
authors: Sevda
authors: S
authors: Gader
authors: Shagayegh
authors: S
authors: Bak Mohammad Zadeh
authors: Aisan
authors: A
authors: Ghasemi
authors: Arezu
authors: A
authors: Poormohammad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004796:Clinical Enzyme Tests; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D061214:Patient Safety; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D008727:Methotrexate
keywords: inflammatory connective tissue disorders; liver transaminases; methotrexate