School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
Southampton General Hospital, Southampton, UK.
Br J Gen Pract. 2022 Jun 30;72(720):e528-e537. doi: 10.3399/BJGP.2021.0595. Print 2022 Jul.
Disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate and azathioprine, are commonly used to treat rheumatoid arthritis (RA) and inflammatory bowel disease (IBD). Blood-test safety monitoring is mainly undertaken in primary care. Normal blood results are common.
To determine the frequency and associations of persistently normal blood tests in patients with RA prescribed methotrexate, and patients with IBD prescribed azathioprine.
Two-year retrospective study of a cohort taken from an electronic pseudonymised primary care/laboratory database covering >1.4 million patients across Hampshire, UK.
Patients with RA and IBD, and associated methotrexate and azathioprine prescriptions, respectively, were identified. Tests and test thresholds recommended by the National Institute for Health and Care Excellence were applied. Persistent normality was defined as no abnormalities of any tests nor alanine aminotransferase (ALT), white blood count (WBC), neutrophils, and estimated glomerular filtration rate (eGFR) individually. Logistic regression was used to identify associations with test normality.
Of 702 265 adults, 7102 had RA and 8597 had IBD. In total, 3001 (42.3%) patients with RA were prescribed methotrexate and 1162 (13.5%) patients with IBD were prescribed azathioprine; persistently normal tests occurred in 1585 (52.8%) and 657 (56.5%) of the populations, respectively. In patients with RA on methotrexate, 585 (19.5%) had eGFR, 219 (7.3%) ALT, 217 (7.2%) WBC, and 202 (6.7%) neutrophil abnormalities. In patients with IBD on azathioprine, 138 (11.9%) had WBC, 88 (7.6%) eGFR, 72 (6.2%) ALT, and 65 (5.6%) neutrophil abnormalities. Those least likely to have persistent test normality were older and/or had comorbidities.
Persistent test normality is common when monitoring these DMARDs, with few hepatic or haematological abnormalities. More stratified monitoring approaches should be explored.
甲氨蝶呤和硫唑嘌呤等疾病修饰抗风湿药物（DMARD）常用于治疗类风湿关节炎（RA）和炎症性肠病（IBD）。血液检测安全性监测主要在初级保健中进行。通常情况下，血液检测结果正常。
确定接受甲氨蝶呤治疗的 RA 患者和接受硫唑嘌呤治疗的 IBD 患者中持续正常血液检测的频率和关联。
这是一项在英国汉普郡的一个电子匿名初级保健/实验室数据库中进行的为期两年的回顾性队列研究，该数据库涵盖了超过 140 万名患者。
分别确定患有 RA 和 IBD 且相关的甲氨蝶呤和硫唑嘌呤处方的患者。应用了英国国家卫生与保健优化研究所推荐的检测和检测阈值。持续正常被定义为没有任何检测异常，也没有丙氨酸氨基转移酶（ALT）、白细胞计数（WBC）、中性粒细胞和估计肾小球滤过率（eGFR）单独异常。使用逻辑回归来确定与检测正常性相关的关联。
在 702265 名成年人中，有 7102 名患有 RA，8597 名患有 IBD。共有 3001 名（42.3%）RA 患者接受了甲氨蝶呤治疗，1162 名（13.5%）IBD 患者接受了硫唑嘌呤治疗；分别在人群中，持续正常检测发生在 1585 名（52.8%）和 657 名（56.5%）患者中。在接受甲氨蝶呤治疗的 RA 患者中，有 585 名（19.5%）有 eGFR 异常，219 名（7.3%）有 ALT 异常，217 名（7.2%）有 WBC 异常，202 名（6.7%）有中性粒细胞异常。在接受硫唑嘌呤治疗的 IBD 患者中，有 138 名（11.9%）有 WBC 异常，88 名（7.6%）有 eGFR 异常，72 名（6.2%）有 ALT 异常，65 名（5.6%）有中性粒细胞异常。那些最不可能持续检测正常的患者年龄较大且/或有合并症。
在监测这些 DMARD 时，持续正常的检测结果很常见，仅有少数肝或血液学异常。应探索更多分层监测方法。
