Qwabe Namuhla, Paruk Farhanah, Mody Girish Mahasukhlal
Department of Rheumatology, School of Clinical Medicine, College of Health Science, University of Kwa-Zulu Natal, Durban, South Africa.
Division of Internal Medicine, University of KwaZulu Natal, Durban, South Africa.
Clin Rheumatol. 2025 Mar;44(3):1069-1079. doi: 10.1007/s10067-025-07310-5. Epub 2025 Feb 6.
Methotrexate (MTX) is the first line therapy for rheumatoid arthritis (RA), and despite its widespread use, there is very little information about MTX intolerance in sub-Saharan Africa. The aim of this study was to assess the prevalence of MTX intolerance and other reasons for stopping MTX in RA in South Africa.
A retrospective chart review of all RA patients seen at Inkosi Albert Luthuli Hospital in Durban from 2009 to 2019 was undertaken. We included patients who received MTX for at least three months. All patients received folic acid supplements. Patients who discontinued MTX were categorized as having either MTX related toxicity or other reasons.
A total of 695 patients were identified with a female to male ratio of 7:1. The mean age was 57.9 (± 13.3) years, and median duration of MTX use was 67.0 (39.0-106.0) months. Most of the patients were African Blacks (61.2%), and Indians (32.8%). There were 83 (11.9%) patients who stopped MTX, and it was successfully reintroduced in 25 of them. Thus, 58 (8.3%) patients discontinued therapy, 33 (4.7%) due to intolerance and 25 (3.6%) due to factors other than adverse effects. The commonest causes of MTX intolerance were respiratory, gastrointestinal and haematological. The other reasons for discontinuation included co-morbidities and pregnancy related concerns.
The low prevalence of MTX intolerance in a multiethnic population in this single centre study, confirms the value of MTX as anchor therapy, especially in resource constrained settings. Key Points • We report a low and similar prevalence of methotrexate intolerance in a large population of African Blacks and Indians with RA in sub-Saharan Africa. • Even though there was heterogeneity among other studies, our review indicates that MTX was tolerated better in our patients compared to patients in Europe and the United States of America.
甲氨蝶呤（MTX）是类风湿关节炎（RA）的一线治疗药物，尽管其应用广泛，但关于撒哈拉以南非洲地区MTX不耐受情况的信息却非常少。本研究的目的是评估南非RA患者中MTX不耐受的患病率以及停用MTX的其他原因。
对2009年至2019年在德班的因科西·阿尔伯特·卢图利医院就诊的所有RA患者进行回顾性病历审查。我们纳入了接受MTX治疗至少三个月的患者。所有患者均接受叶酸补充剂。停用MTX的患者被归类为患有MTX相关毒性或其他原因。
共确定695例患者，女性与男性比例为7:1。平均年龄为57.9（±13.3）岁，MTX使用的中位持续时间为67.0（39.0 - 106.0）个月。大多数患者为非洲黑人（61.2%）和印度人（32.8%）。有83例（11.9%）患者停用MTX，其中25例成功重新使用。因此，58例（8.3%）患者停止治疗，33例（4.7%）因不耐受，25例（3.6%）因不良反应以外的因素。MTX不耐受的最常见原因是呼吸、胃肠道和血液系统方面的问题。停用的其他原因包括合并症和与妊娠相关的问题。
在这项单中心研究的多民族人群中，MTX不耐受的患病率较低，这证实了MTX作为基础治疗的价值，尤其是在资源有限的环境中。要点 • 我们报告在撒哈拉以南非洲地区大量患有RA的非洲黑人和印度人群中，甲氨蝶呤不耐受的患病率较低且相似。 • 尽管其他研究存在异质性，但我们的综述表明，与欧洲和美国的患者相比，我们的患者对MTX的耐受性更好。
