Goldsmith P, Roach A
Department of Neurology, Addenbrooke's Hospital, Cambridge, and DanioLads Ltd, Cambridge, UK.
J Clin Pharm Ther. 2007 Aug;32(4):327-31. doi: 10.1111/j.1365-2710.2007.00834.x.
The treatment of chronic inflammatory conditions often involves a difficult balance between the benefits of disease modification and the risks attendant with the use of disease-modifying agents. Methotrexate is a useful and commonly used disease-modifying agent but has a particularly notable reputation for causing morbidity and mortality. We explore ways in which the safety of methotrexate prescribing may be improved. There has been considerable debate as to the whether some of the side-effects can be mitigated by co-prescription of folate with methotrexate. Whereas no definitive conclusion can yet be reached, evidence suggests that the improvement in side-effect profile is limited to fewer elevations of liver enzymes, but that this may be at the expense of decreased methotrexate efficacy. The question remains as to whether the improved tolerability more than compensates for the decreased efficacy or whether folic acid should be used in a more circumspect way. However, a very specific danger arises from the fact that methotrexate is prescribed once weekly for inflammatory conditions, leading to errors at both the prescription and patient level. We highlight simple ways of improving safety to decrease such errors.
慢性炎症性疾病的治疗通常需要在疾病改善的益处与使用改善病情药物所带来的风险之间艰难权衡。甲氨蝶呤是一种有用且常用的改善病情药物，但因其会导致发病和死亡而声名狼藉。我们探讨了提高甲氨蝶呤处方安全性的方法。关于是否可以通过联合使用叶酸与甲氨蝶呤来减轻一些副作用，一直存在相当多的争论。虽然尚未得出明确结论，但有证据表明，副作用的改善仅限于肝酶升高次数减少，但这可能是以甲氨蝶呤疗效降低为代价的。问题仍然是，耐受性的提高是否足以弥补疗效的降低，或者叶酸是否应该以更谨慎的方式使用。然而，由于甲氨蝶呤针对炎症性疾病每周给药一次，在处方和患者层面都会导致错误，这就产生了一个非常特殊的危险。我们强调了提高安全性以减少此类错误的简单方法。
