Vol.23 No.3

Original Article

The time course of gastric methotrexate intolerance in patients with rheumatoid arthritis and psoriatic arthritis

Authors

Ediz Dalkilic1, 5 , Mustafa Sahbazlar2 , Mustafa Gullulu3 , Mahmut Yavuz3 , Kamil Dilek3 , Alpaslan Ersoy3 , Guven Ozkaya4 , Mustafa Yurtkuran3

  • Division of Rheumatology, Department of Internal Medicine, Uludag Medical Faculty, Uludag University, Bursa, Turkey
  • Department of Internal Medicine, Uludag Medical Faculty, Uludag University, Bursa, Turkey
  • Division of Nephrology, Department of Internal Medicine, Uludag Medical Faculty, Uludag University, Bursa, Turkey
  • Department of Biostatistics, Uludag Medical Faculty, Uludag University, Bursa, Turkey
  • Bademli mah., Egitim cad., Gumuskoy sitesi, 24/20 Mudanya, Bursa, Turkey
Received:

29 February 2012

Accepted:

28 May 2012

Published online:

30 June 2012

Full Text

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Abstract

Objectives This study aimed to evaluate the incidence and the time course of methotrexate (MTX)-associated gastric intolerance in patients with rheumatoid arthritis and psoriatic arthritis.
Methods Four hundred twenty subjects undergoing MTX treatment for rheumatoid arthritis (n = 346) and psoriatic arthritis (n = 74) were retrospectively assessed. The incidence and time course of gastric MTX intolerance resulting in treatment discontinuation were investigated. In addition, the relations between gastric intolerance and patient characteristics, including gender, age, diagnosis, and rheumatoid factor (RF) positivity, were examined.
Results Overall, oral MTX discontinuation rate due to gastric intolerance was 28.6 %. The time to discontinuation for oral MTX was 8.1 ± 11.5 months on average, with more than half of the discontinuations occurring within the first three months of treatment. Discontinuation was not associated with gender, age, diagnosis, or RF positivity. More than half of the patients that switched to a parenteral treatment regimen (52.6 %, 20/38) could tolerate the agent.
Conclusions Gastric MTX intolerance usually develops within the first year of treatment and presents a major obstacle to long-term treatment retention in patients with rheumatologic disease. However, parenteral MTX appears to be a good alternative for patients intolerant of oral MTX.

Key words

Methotrexate, Intolerance, Time course, Rheumatoid arthritis, Psoriatic arthritis