Admin_Adham
TOPLINE
Patients with rheumatic diseases receiving methotrexate (MTX) who were monitored every 6 months showed no increase in liver function test abnormalities, blood count abnormalities, or fibrosis progression compared with those monitored every 3 months.
METHODOLOGY
- Researchers conducted an observational cohort analysis of 14,199 laboratory encounters from 2439 patients receiving MTX with at least 2 measurements of alanine aminotransferase (ALT) levels, aspartate aminotransferase (AST) levels, white blood cell (WBC) count, hematocrit (HCT), mean corpuscular volume (MCV), and platelet (PLT) count over a 9-year period from 2017 to 2025.
- Adult patients (79% women; 63% White) seen at rheumatology clinics and who had been prescribed MTX for more than 90 days prior to laboratory testing were included.
- Monitoring intervals of 3 months (45-135 days) and 6 months (135-225 days) were compared using propensity score matching to assess incident laboratory abnormalities, with 1151 and 1620 patients in the respective groups.
- Fibrosis-4 (FIB-4) scores were calculated whenever possible to estimate liver scarring, and changes in consecutive laboratory measurements were plotted against their corresponding time intervals.
TAKEAWAY
- Testing frequency showed no meaningful correlation with changes in ALT, AST, WBC, HCT, MCV, PLT, or FIB-4 (all R2 < 0.01).
- Mean laboratory values did not differ significantly between the monitoring intervals in an adjusted analysis.
- Patients monitored every 6 months were equally or less likely to develop incident abnormal results than those monitored every 3 months; most odds ratios (ORs) were not statistically significant.
- The testing period of 6 months was a protective factor only in the case of MCV > 100 fL in a generalized linear mixed-effects model (OR, 0.815; 95% CI, 0.812-0.818).
IN PRACTICE
"[The study] findings suggest that the burden of frequent laboratory monitoring for patients on long-term MTX therapy may outweigh its clinical value. Revisiting and potentially revising guideline-recommended monitoring intervals could meaningfully improve patient experience and reduce healthcare system demands without compromising safety," the authors wrote.
SOURCE
The study was led by Spencer Simko, BS, University of Texas Southwestern Medical School in Dallas. It was published online on July 22 in Arthritis Care & Research.
LIMITATIONS
This single-center study might restrict generalizability to other practice settings or more diverse populations. The observational design prevented causal inferences, and limited statistical power was noted for less frequent outcomes.
DISCLOSURES
No specific funding was received for this work. One author reported receiving royalties from UpToDate and fees for participation in a data safety monitoring board or advisory board; another author reported receiving payment or honoraria for lectures.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
