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Sobue Y, Suzuki M, Ohashi Y, Koshima H, Okui N, Funahashi K, Ishikawa H, Inoue H, Asai S, Terabe K, Kishimoto K, Kihira D, Maeda M, Sato R, Imagama S. Relationship between frailty and methotrexate discontinuation due to adverse events in rheumatoid arthritis patients. Clin Rheumatol 2023:10.1007/s10067-023-06639-z. [PMID: 37211570 DOI: 10.1007/s10067-023-06639-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Methotrexate (MTX) is an anchor drug in the treatment of rheumatoid arthritis (RA). Frailty is the intermediate condition between being healthy and disabled, and can lead to negative health outcomes. Adverse events (AEs) due to RA drugs are expected to be higher in frail patients. The present study aimed to investigate the relationship between frailty and MTX discontinuation due to AEs in RA patients. METHODS Of 538 RA patients who visited us between June and August 2020 as part of the retrospective T-FLAG study, 323 used MTX. After 2 years of follow-up, we investigated AEs leading to MTX discontinuation. Frailty was defined as a Kihon Checklist (KCL) score ≥ 8. Cox proportional hazards regression analysis was performed to identify factors associated with MTX discontinuation due to AEs. RESULTS Of the 323 RA patients (251 women, 77.7%) who used MTX, 24 (7.4%) discontinued MTX due to AEs during the 2-year follow-up period. Mean ages in the MTX continuation/discontinuation groups were 64.5 ± 13.9/68.5 ± 11.7 years (p = 0.169), Clinical Disease Activity Index was 5.6 ± 7.3/6.2 ± 6.0 (p = 0.695); KCL was 5.9 ± 4.1/9.0 ± 4.9 points (p < 0.001); and the proportion of frailty was 31.8%/58.3% (p = 0.012). MTX discontinuation due to AEs was significantly associated with frailty (hazard ratio 2.34, 95% confidence interval 1.02-5.37) even after adjusting for age and diabetes mellitus. AEs included liver dysfunction (25.0%), pneumonia (20.8%), and renal dysfunction (12.5%). CONCLUSIONS Because frailty is a significant factor contributing to MTX discontinuation due to AEs, the latter should be carefully monitored in frail RA patients who use MTX. Key Points • Of the 323 rheumatoid arthritis (RA) patients (251 women, 77.7%) who used methotrexate (MTX), 24 (7.4%) discontinued MTX due to adverse events (AEs) during the 2-year follow-up period. • MTX discontinuation due to AEs was significantly associated with frailty (hazard ratio 2.34, 95% confidence interval 1.02-5.37) even after adjusting for age and diabetes mellitus, and neither the MTX dose, folic acid supplementation, nor GC co-therapy were factors in MTX discontinuation. • Frailty is a predominant factor in MTX discontinuation among established, long-term pretreated RA patients, and the occurrence of AEs due to MTX should be carefully monitored when frail RA patients use MTX.
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Affiliation(s)
- Yasumori Sobue
- Department of Orthopedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita, Nakamura, Nagoya, Aichi, 453-8511, Japan.
| | - Mochihito Suzuki
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
- Department of Orthopedic Surgery, Japan Community Healthcare Organization Kani Tono Hospital, 1221-5 Dota, Kani, Gifu, 509-0206, Japan
| | - Yoshifumi Ohashi
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
- Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi, Mie, 510-8567, Japan
| | - Hiroshi Koshima
- Department of Orthopedic Surgery, Japan Community Healthcare Organization Kani Tono Hospital, 1221-5 Dota, Kani, Gifu, 509-0206, Japan
| | - Nobuyuki Okui
- Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi, Mie, 510-8567, Japan
| | - Koji Funahashi
- Department of Orthopedic Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi, Kariya, Aichi, 448-0852, Japan
| | - Hisato Ishikawa
- Department of Orthopedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita, Nakamura, Nagoya, Aichi, 453-8511, Japan
| | - Hidenori Inoue
- Department of Orthopedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita, Nakamura, Nagoya, Aichi, 453-8511, Japan
| | - Shuji Asai
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Kenya Terabe
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Kenji Kishimoto
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Daisuke Kihira
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Masataka Maeda
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Ryo Sato
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
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Sobue Y, Suzuki M, Ohashi Y, Koshima H, Okui N, Funahashi K, Ishikawa H, Inoue H, Kojima M, Asai S, Terabe K, Hattori K, Kishimoto K, Takahashi N, Imagama S, Kojima T. Association between locomotive syndrome and methotrexate discontinuation due to adverse events in rheumatoid arthritis patients: A retrospective observational study. Geriatr Gerontol Int 2022; 22:904-905. [PMID: 36039830 DOI: 10.1111/ggi.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Yasumori Sobue
- Department of Orthopedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Mochihito Suzuki
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Orthopedic Surgery, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Yoshifumi Ohashi
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Hiroshi Koshima
- Department of Orthopedic Surgery, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Nobuyuki Okui
- Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Koji Funahashi
- Department of Orthopedic Surgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Hisato Ishikawa
- Department of Orthopedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Hidenori Inoue
- Department of Orthopedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Masayo Kojima
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shuji Asai
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenya Terabe
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyosuke Hattori
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Kishimoto
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobunori Takahashi
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Orthopedic Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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