Methotrexate dosage and laboratory monitoring in patients with psoriasis and psoriatic arthritis: A retrospective analysis of prescription patterns and financial impact in dermatology and rheumatology settings.

IF 3.2 4区 医学 Q2 DERMATOLOGY
Gopikrishnan Anjaneyan, Prateek Nayak, Jyothish R Pillai, Mithun Cb, Lekshmi Sajini, Soumya Jagadeesan, Vinitha Varghese Panicker
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引用次数: 0

Abstract

Background Methotrexate (MTX) is a disease-modifying drug used for psoriasis (PsO) and psoriatic arthritis (PsA), but dermatology and rheumatology guidelines differ in dosing and monitoring recommendations. Objectives To compare methotrexate dosing and monitoring practices in dermatology and rheumatology, assess adverse drug reactions, and analyse the financial impact of rigorous monitoring. Methods This observational, electronic medical record-based retrospective chart review included psoriasis and psoriatic arthritis patients started on methotrexate at the dermatology and rheumatology departments at a tertiary care centre in 2020-2021. Patients with concurrent hepatotoxic/myelotoxic medications, inadequate follow-up, or abnormal baseline laboratory tests were excluded. Data regarding demographics, relevant medical histories, clinical variables, methotrexate dosing, frequency of laboratory monitoring, adverse events, and resource utilization were recorded and analysed. Descriptive statistics (means/percentages) and inferential tests (Chi-Square Test or Mann- Whitney Test) were used based on data normality (p<0.05 considered significant). Results The study included 100 psoriasis and psoriatic arthritis patients each. The psoriatic arthritis patients were given higher methotrexate doses initially but underwent less frequent laboratory monitoring compared to psoriasis patients. The incidence of hepatotoxicity was comparable between the two groups. However, leukopenia was observed more frequently in psoriatic arthritis patients. Methotrexate monitoring under dermatologists cost 44% more than that under rheumatologists over 6 months (Rs 4766.08± 1631.9 vs Rs 3290.32± 1207.8). Limitations The single centre, small sample size, retrospective chart review, and convenience sampling in this study may all limit the generalisability of the findings. Conclusion Current methotrexate guidelines in dermatology recommend lower doses and more frequent monitoring than rheumatology guidelines. Insights from this study and comparison with rheumatology practices and existing literature highlight the potential for designing large-scale, multicentric, non-inferiority studies that could eventually help develop more efficient and streamlined methotrexate monitoring protocols for dermatology and rheumatology, ultimately improving patient adherence, safety and affordability.

银屑病和银屑病关节炎患者的甲氨蝶呤剂量和实验室监测:皮肤病学和风湿病学设置处方模式和财务影响的回顾性分析。
甲氨蝶呤(MTX)是一种用于治疗银屑病(PsO)和银屑病关节炎(PsA)的疾病改善药物,但皮肤科和风湿病学指南在剂量和监测建议方面存在差异。目的比较皮肤病学和风湿病学的甲氨蝶呤剂量和监测做法,评估药物不良反应,并分析严格监测的财务影响。方法:本观察性、基于电子病历的回顾性图表综述纳入了2020-2021年在三级保健中心皮肤科和风湿科开始使用甲氨蝶呤的银屑病和银屑病关节炎患者。排除同时使用肝毒性/骨髓毒性药物、随访不充分或基线实验室检查异常的患者。记录和分析有关人口统计学、相关病史、临床变量、甲氨蝶呤剂量、实验室监测频率、不良事件和资源利用的数据。基于数据正态性,采用描述性统计(均值/百分比)和推理检验(卡方检验或曼-惠特尼检验)
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来源期刊
CiteScore
2.10
自引率
10.30%
发文量
247
审稿时长
6-12 weeks
期刊介绍: The Indian Association of Dermatologists, Venereologists & Leprologists (IADVL) is the national association of Indian medical specialists who manage patients with skin disorders, sexually transmitted infections (STIs) or leprosy. The current member strength of the association is about 3800. The association works for the betterment of the specialty by holding academic meetings, printing a journal and publishing a textbook. The IADVL has several state branches, each with their own office bearers, which function independently within the constitution of the IADVL. Established in 1940, the Indian Journal of Dermatology, Venereology and Leprology (IJDVL, ISSN 0378-6323) is the official publication of the IADVL (Indian Association of Dermatologists, Venereologists and Leprologists).
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