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Quantitative Determination of Methotrexate, 7-Hydroxymethotrexate, and Methotrexate Polyglutamates in Human Erythrocytes by High-Performance Liquid Chromatography with Mass Spectrometry. Pharm Chem J 2022. [DOI: 10.1007/s11094-022-02643-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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2
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Musdalita E, Hidayat R, Sumariyono S, Kusumo Wibowo SA, Ariane A, Shatri H, Rengganis I, Antono D. Correlation between serum methotrexate-polyglutamate 3 (MTX-PG3) level and disease activity in rheumatoid arthritis patients: A prospective cohort study. F1000Res 2022; 11:187. [PMID: 35284067 PMCID: PMC8891717 DOI: 10.12688/f1000research.108714.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is one of the most common autoimmune diseases, characterized by systemic inflammation, joint destruction and disability. Methotrexate (MTX) is used as the primary treatment for RA patients. However, the response to MTX therapy is highly varied and difficult to predict. This study sought to determine the role of MTX by measuring the MTX polyglutamate 3 (MTX-PG3) levels and the disease activity score 28 based on C-reactive protein (DAS28-CRP) of RA patients. Method: A prospective cohort study was conducted at the Rheumatology Polyclinic of Dr. Cipto Mangunkusumo General Hospital. Thirty-four patients with RA were included and followed up to 12 weeks. The RA patients were treated with MTX 10 mg per week and an increased dose of 5 mg per week every month. DAS28-CRP and MTX-PG3 level were assessed at week 8 and 12. Multivariate logistic regression analysis was used to determine the correlation between MTX-PG3 and DAS28-CRP. Result: A total of 34 RA patients were followed and the MTX was well tolerated in which no increase of serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and glomerular filtration rate (GFR) were observed. The mean scores of DAS28-CRP decreased following the MTX-treatment: 3.93, 3.22 and 2.82 at week 0, 8 and 12, respectively. In contrast, the median concentration of MTX-PG3 increased from week 8 to week 12 followed by increasing the dose of MTX. Our analysis suggested there was a moderate positive correlation between MTX-PG3 levels and DAS28-CRP score at week 8 and week 12 post-MTX treatment. Conclusion: The level of MTX-PG3 is correlated with DAS28-CRP score suggesting that MTX-PG3 could be used as an indicator to assess the disease activity in RA patients. Nevertheless, a prospective study with a higher number of patients is needed to confirm this finding.
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Affiliation(s)
- Eva Musdalita
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine,, Universitas Indonesia/ Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Rudy Hidayat
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine,, Universitas Indonesia/ Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Sumariyono Sumariyono
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine,, Universitas Indonesia/ Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Suryo Anggoro Kusumo Wibowo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine,, Universitas Indonesia/ Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Anna Ariane
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine,, Universitas Indonesia/ Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Hamzah Shatri
- Division of Psychosomatic and Palliative Care, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Iris Rengganis
- Division of Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Dono Antono
- Division of Cardiovascular, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Laube R, Paramsothy S, Leong RW. Use of medications during pregnancy and breastfeeding for Crohn's disease and ulcerative colitis. Expert Opin Drug Saf 2021; 20:275-292. [PMID: 33412078 DOI: 10.1080/14740338.2021.1873948] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: The peak age of diagnosis of inflammatory bowel disease (IBD) occurs during childbearing years, therefore management of IBD during pregnancy is a frequent occurrence. Maintenance of disease remission is crucial to optimize pregnancy outcomes, and potential maternal or fetal toxicity from medications must be balanced against the risks of untreated IBD.Areas covered: This review summarizes the literature on safety and use of medications for IBD during pregnancy and lactation.Expert opinion: 5-aminosalicylates, corticosteroids and thiopurines are safe for use during pregnancy, while methotrexate and tofacitinib should only be used with extreme caution. Anti-TNF agents (except certolizumab), vedolizumab, ustekinumab and tofacitinib readily traverse the placenta via active transport, therefore theoretically may affect fetal development. Certolizumab only undergoes passive transfer across the placenta, thus has markedly lower cord blood levels making it likely the safest biologic agent for infants. There is reasonable evidence to support the safety of anti-TNF monotherapy and combination therapy during pregnancy and lactation. Vedolizumab and ustekinumab are also thought to be safe in pregnancy and lactation, while tofacitinib is generally avoided due to teratogenic effects in animal studies.
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Affiliation(s)
- Robyn Laube
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Department of Gastroenterology, Macquarie University Hospital, Sydney, Australia
| | - Sudarshan Paramsothy
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Department of Gastroenterology, Macquarie University Hospital, Sydney, Australia.,Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia
| | - Rupert W Leong
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Department of Gastroenterology, Macquarie University Hospital, Sydney, Australia.,Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia
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4
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Rostang A, Desjardins I, Espana B, Panzuti P, Berny P, Prouillac C, Pin D. Pharmacokinetics of low-dose methotrexate in horses. J Vet Pharmacol Ther 2020; 43:461-469. [PMID: 32216109 DOI: 10.1111/jvp.12857] [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: 11/13/2019] [Revised: 02/10/2020] [Accepted: 02/28/2020] [Indexed: 11/30/2022]
Abstract
This study aimed to investigate both the pharmacokinetic behavior and tolerance of methotrexate (MTX) in horses to design a specific dosing regimen as a new immunomodulatory drug for long-term treatment. To determine the primary plasma pharmacokinetic variables after single intravenous, subcutaneous or oral administration, six horses were administered 0.3 mg/kg MTX in a crossover design study. After a 10-week washout, MTX was administered subcutaneously to three of the six previously treated horses at a dose of 0.3 mg/kg once per week for 3 months. In both studies, MTX and metabolite concentrations were measured using LC-MS/MS. The absolute bioavailability of MTX was 73% following subcutaneous administration but less than 1% following oral administration. The plasma clearance was 1.54 ml min-1 kg-1 (extraction ratio = 2%). After 24 hr, plasma concentrations were below the LOQ. No adverse effects were noted except for a moderate reversible elevation in liver enzymes (GLDH). With regards to the main metabolites of MTX, very low concentrations of 7-hydroxy-MTX were found, whereas polyglutamated forms (mainly short chains) were found in red blood cells. A subcutaneous dose of 0.2 mg kg-1 week-1 may be safe and relevant in horses, although this has yet to be clinically confirmed.
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Affiliation(s)
- Antoine Rostang
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Isabelle Desjardins
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Bernadette Espana
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Pauline Panzuti
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Philippe Berny
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Caroline Prouillac
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Didier Pin
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
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5
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Methotrexate Polyglutamate Values in Children and Adolescents With Acute Lymphoblastic Leukemia During Maintenance Therapy. J Pediatr Hematol Oncol 2019; 41:429-432. [PMID: 31259826 DOI: 10.1097/mph.0000000000001530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inadequate adherence to maintenance therapy is a major cause of relapse in patients with acute lymphoblastic leukemia (ALL). Therapeutic monitoring of mercaptopurine (thiopurine) red cell metabolites to assess adherence has been available for many years. Recently a clinical laboratory improvement amendments of 1988-approved test for methotrexate with three polyglutamate residues (MTXPG3) measured in peripheral blood red cells was approved. MTXPG3 is the primary intracellular metabolite of methotrexate, and like thiopurine metabolites, is retained for the life of the red cell giving an estimate of drug exposure over time. Normative values for MTXPG3 are available for adults and children with rheumatoid arthritis on methotrexate monotherapy, which are not applicable for patients with ALL on maintenance. Older literature on the MTXPG3 fraction in children with ALL is limited. We examined the MTXPG3 levels from 123 samples in 76 patients with ALL on maintenance oral methotrexate and mercaptopurine that were collected for clinical care. Male individuals had significantly higher MTXPG3 levels than female individuals which was unrelated to absolute neutrophil count, age, serum creatinine, and average doses of methotrexate or mercaptopurine. The MTXPG3 5th, 10th, 90th, and 95th percentile values are 0, 8.4, 53, and 64, respectively with a median of 24.7 nmol/L. The low 5th percentile MTXPG3 reflects 6 samples from 3 patients, age 16 to 21 years that were considered poorly adherent before collecting the specimen. As with red cell thiopurine (mercaptopurine) metabolites, MTXPG3 normative values may provide useful information to monitor for poor patient adherence or methotrexate toxicity during maintenance chemotherapy in ALL.
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Yousef FMA, Khattab HARH, Sindi HAA. Effectiveness of Moringa oleifera L. Leaves Extract Against Methotrexate-induced Acute Hepatotoxicity in Male Rats. INT J PHARMACOL 2018. [DOI: 10.3923/ijp.2018.1029.1037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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7
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Tsakok T, Jabbar-Lopez Z, Smith C. Subcutaneous methotrexate in patients with moderate-to-severe psoriasis: a critical appraisal. Br J Dermatol 2018; 179:50-53. [DOI: 10.1111/bjd.16424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- T. Tsakok
- St John's Institute of Dermatology; King's College London and Guy's and St Thomas’ NHS Foundation Trust; Great Maze Pond London SE1 9RT U.K
| | - Z.K. Jabbar-Lopez
- St John's Institute of Dermatology; King's College London and Guy's and St Thomas’ NHS Foundation Trust; Great Maze Pond London SE1 9RT U.K
| | - C.H. Smith
- St John's Institute of Dermatology; King's College London and Guy's and St Thomas’ NHS Foundation Trust; Great Maze Pond London SE1 9RT U.K
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8
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Murosaki T, Nagatani K, Sato T, Akiyama Y, Ushijima K, Lefor AK, Fujimura A, Minota S. Prediction of the therapeutic response to methotrexate at 24 weeks by methotrexate–polyglutamates concentration in erythrocytes at 8 weeks in patients with rheumatoid arthritis. Mod Rheumatol 2016; 27:411-416. [DOI: 10.1080/14397595.2016.1208137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Takamasa Murosaki
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan,
| | - Katsuya Nagatani
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan,
| | - Takeo Sato
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan,
| | - Yoichiro Akiyama
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan,
| | - Kentaro Ushijima
- Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University, Shimotsuke, Tochigi, Japan, and
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Akio Fujimura
- Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University, Shimotsuke, Tochigi, Japan, and
| | - Seiji Minota
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan,
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Rademaker M, Gupta M, Andrews M, Armour K, Baker C, Foley P, Gebauer K, George J, Rubel D, Sullivan J. The Australasian Psoriasis Collaboration view on methotrexate for psoriasis in the Australasian setting. Australas J Dermatol 2016; 58:166-170. [PMID: 27402434 DOI: 10.1111/ajd.12521] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/19/2016] [Indexed: 02/06/2023]
Abstract
The Australasian Psoriasis Collaboration reviewed methotrexate (MTX) in the management of psoriasis in the Australian and New Zealand setting. The following comments are based on expert opinion and a literature review. Low-dose MTX (< 0.4 mg/kg per week) has a slow onset of action and has moderate to good efficacy, together with an acceptable safety profile. The mechanism of action is anti-inflammatory, rather than immunosuppressive. For pretreatment, consider testing full blood count (FBC), liver and renal function, non-fasting lipids, hepatitis serology, HbA1c and glucose. Body mass index and abdominal circumference should also be measured. Optional investigations in at-risk groups include an HIV test, a QuantiFERON-TB Gold test and a chest X-ray. In patients without complications, repeat the FBC at 2-4 weeks, then every 3-6 months and the liver/renal function test at 3 months and then every 6 months. There is little evidence that a MTX test dose is of value. Low-dose MTX rarely causes clinically significant hepatotoxicity in psoriasis. Most treatment-emergent liver toxicity is related to underlying metabolic syndrome and non-alcoholic fatty liver disease or non-alcoholic steatohepatitis. Alcohol itself is not contraindicated, but should be limited to < 20 gm/day. [Correction added on 6 January 2017, after first online publication: '20 mg/day' has been corrected to '20 gm/day'.] Although MTX is a potential teratogen post-conception, there is little evidence for this pre-conception. MTX does not affect the quality of sperm. There is no evidence that MTX reduces healing, so there is no specific need to stop MTX peri-surgery. MTX may be used in combination with cyclosporine, acitretin, prednisone and anti-tumour necrosis factor biologics.
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Affiliation(s)
- Marius Rademaker
- Department of Dermatology, Waikato Clinical Campus, Auckland Medical School, Hamilton, New Zealand
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia.,Department of Medicine, UNSW, Sydney, New South Wales, Australia
| | - Megan Andrews
- Dermatology, Specialist Connect, Woolloongabba, Queensland, Australia
| | - Katherine Armour
- Department of Dermatology, The Alfred Hospital, Melbourne, Victoria, Australia.,Skin and Cancer Foundation Inc, Melbourne, Victoria, Australia
| | - Chris Baker
- Skin and Cancer Foundation Inc, Melbourne, Victoria, Australia.,Department of Medicine (Dermatology), The University of Melbourne, Melbourne, Victoria, Australia.,Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter Foley
- Skin and Cancer Foundation Inc, Melbourne, Victoria, Australia.,Department of Medicine (Dermatology), The University of Melbourne, Melbourne, Victoria, Australia.,Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Kurt Gebauer
- Department of Dermatology, University of Western Australia, Perth, Western Australia, Australia
| | - Jacob George
- Department of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine, Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Diana Rubel
- Department of Dermatology, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Department of Dermatology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - John Sullivan
- Department of Medicine, UNSW, Sydney, New South Wales, Australia.,Dermatology, Holdsworth House Medical Practice, Sydney, New South Wales, Australia
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10
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Abstract
Non-adherence to treatment and medical recommendations is one of the leading causes of treatment failure, poor clinical outcomes, and increased healthcare utilization. Although non-adherence is observed across all medical specialties, adherence to treatment in dermatology deserves special attention given the multiple different routes of treatment. Adherence can be measured using subjective methods (patient reporting and questionnaires) or objective methods (pill counts, electronic chips, and pharmacy records). Adherence to dermatologic treatments varies based on the specific condition but is poor for systemic therapies and even worse with topical agents. Among the factors that influence adherence, duration of treatment, complexity of regimen, and access play a large role. Interventions to improve adherence can range from simplifying treatment regimens to scheduling more frequent office visits. Due to the profound effect on cost, healthcare outcomes, and mortality, understanding and improving adherence is equally as important as making the correct diagnosis and prescribing the correct treatment.
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Affiliation(s)
- Christine S Ahn
- a Department of Dermatology , Center for Dermatology Research, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Leonora Culp
- a Department of Dermatology , Center for Dermatology Research, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - William W Huang
- a Department of Dermatology , Center for Dermatology Research, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Scott A Davis
- a Department of Dermatology , Center for Dermatology Research, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Steven R Feldman
- a Department of Dermatology , Center for Dermatology Research, Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Pathology & Public Health Sciences, Wake Forest School of Medicine , Winston-Salem , NC , USA
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11
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Val/Val glutathione-S-transferase P1 polymorphism predicts nonresponders in psoriasis patients treated with fumaric acid esters. Pharmacogenet Genomics 2016; 26:248-53. [DOI: 10.1097/fpc.0000000000000218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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12
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Abstract
In the era of biologic therapies, methotrexate (MTX), a classic immunomodulator, is still the cornerstone of systemic treatment of psoriasis. MTX has been used for many years, achieving good responses with a good safety profile. However, only a few randomized clinical trials have been performed involving MTX, and most of the current evidence comes from pivotal studies of biologic drugs. The aim of this article is to make an extensive review of the MTX mechanism of action, pharmacokinetics, efficacy, safety and tolerability, especially focusing on the future perspective of this old drug and recent advances in the field of pharmacogenetics.
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Affiliation(s)
- Oriol Yélamos
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
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13
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The methotrexate polyglutamate assay supports the efficacy of methotrexate for severe inflammatory skin disease in children. J Am Acad Dermatol 2014; 70:252-6. [DOI: 10.1016/j.jaad.2013.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 11/24/2022]
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14
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Thorneloe RJ, Bundy C, Griffiths CEM, Ashcroft DM, Cordingley L. Adherence to medication in patients with psoriasis: a systematic literature review. Br J Dermatol 2013; 168:20-31. [PMID: 22963128 DOI: 10.1111/bjd.12039] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Psoriasis is associated with considerable physical and psychological morbidity. Optimal use of psoriasis treatments can limit the physical manifestations of psoriasis and help improve quality of life, but nonadherence is common. Smoking, obesity and excessive alcohol consumption are prevalent in this population. A systematic review of adherence to medication and recommendations for lifestyle change in psoriasis was undertaken, with a critical appraisal of the quality of the selected studies. Electronic searches from inception to March 2012 (PubMed, Web of Science and Embase) were conducted. Twenty-nine studies were included; however, none examined adherence to advice about lifestyle change. Studies using a dichotomous classification of adherence tended to report suboptimal adherence, with 21·6-66·6% of patients classed as adherent. No consistent pattern of results emerged for sociodemographical, disease and lifestyle factors as determinants of adherence. However, some treatment factors were associated with adherence. While mixed findings were reported for quality of life as a determinant of adherence, psychological factors (psychological distress and patient satisfaction with care and therapy) were associated with adherence. Only tentative conclusions can be made for determinants of adherence because the methodological quality of many of the included studies limits conclusions. There is a need for improved quality of research and reporting in this area, and this review provides a platform from which future research within this area should progress, along with suggested research recommendations.
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Affiliation(s)
- R J Thorneloe
- Dermatology Research Centre, Institute of Inflammation and Repair.
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15
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Becher G, Burden AD. Understanding the variation in response to methotrexate. Br J Dermatol 2012; 167:2-3. [PMID: 22738410 DOI: 10.1111/j.1365-2133.2012.11028.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G Becher
- Department of Dermatology, Western Infirmary, Glasgow G11 6NT, UK
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