Division of Rheumatology, Department of Internal Medicine, Uludag Medical Faculty, Uludag University, Bursa, Turkey.
Mod Rheumatol. 2013 May;23(3):525-8. doi: 10.1007/s10165-012-0685-y. Epub 2012 Jun 30.
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.
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.
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.
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.
本研究旨在评估甲氨蝶呤（MTX）相关胃不耐受在类风湿关节炎和银屑病关节炎患者中的发生率和时间进程。
回顾性评估了 420 名接受 MTX 治疗的类风湿关节炎（n=346）和银屑病关节炎（n=74）患者。研究了导致治疗中断的胃 MTX 不耐受的发生率和时间进程。此外，还检查了胃不耐受与患者特征（包括性别、年龄、诊断和类风湿因子（RF）阳性）之间的关系。
总体而言，由于胃不耐受而停止口服 MTX 的发生率为 28.6%。口服 MTX 的平均停药时间为 8.1±11.5 个月，超过一半的停药发生在治疗的头三个月内。停药与性别、年龄、诊断或 RF 阳性无关。超过一半的患者（52.6%，20/38）能够耐受转换为肠外治疗方案的药物。
胃 MTX 不耐受通常在治疗的头一年内发生，是风湿性疾病患者长期治疗保留的主要障碍。然而，肠外 MTX 似乎是不耐受口服 MTX 的患者的良好替代选择。
