FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2904271014> ?p ?o ?g. }

• W2904271014 endingPage "1162" @default.
• W2904271014 startingPage "1160" @default.
• W2904271014 abstract "To the Editor: Many dermatologists initiate methotrexate with a small test dose (TD), followed by laboratory evaluation before the second dose. Intended to minimize the risk for early adverse events, this practice has been noted in guidelines,1Pathirana D. Ormerod A.D. Saiag P. et al.European S3-guidelines on the systemic treatment of psoriasis vulgaris.J Eur Acad Dermatol Venereol. 2009; 23: 1-70Crossref PubMed Scopus (579) Google Scholar, 2Menter A. Korman N.J. Elmets C.A. et al.Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents.J Am Acad Dermatol. 2009; 61: 451-485Abstract Full Text Full Text PDF PubMed Scopus (459) Google Scholar though some have questioned its necessity.3Carretero-Hernandez G. Methotrexate in psoriasis: do we need to give a test dose?.Actas Dermosifiliogr. 2012; 103: 1-4Google Scholar Clinical trials utilizing methotrexate without a TD have reported a low incidence of serious adverse events.4Warren R.B. Mrowietz U. von Kiedrowski R. et al.An intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe plaque-type psoriasis (METOP): a 52 week, multicentre, randomized, double-blind, placebo-controlled, phase 3 trial.Lancet. 2017; 389: 528-537Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar We performed a retrospective study to compare the frequency of adverse events in patients initiating methotrexate with and without a TD. Our electronic medical records were searched for patients with a new prescription for methotrexate from dermatology or rheumatology during 2010-2015. Patients were included if use of a TD, the initial dose, dose changes, date and reason of discontinuation, and baseline and follow-up laboratory values for a 4-month period after initiation of methotrexate were documented. TD was defined as an initial methotrexate dose of ≤10 mg and laboratory monitoring before the second weekly methotrexate dose. Laboratory values were graded according to standard terminology.5National Cancer Institute common terminology criteria for adverse events v5.0.file:///G:/Methotrexate%20project%20articles/CTCAE_v5_Quick_Reference_8.5x11.pdfDate accessed: November 12, 2018Google Scholar The initial search identified 812 patients; 174 met inclusion criteria. Most dermatology patients received a TD, and most rheumatology patients did not (Table I). As expected, the initial methotrexate dose was lower in the TD group, but both groups had a mean initial dose <10 mg, with a range of 5-15 mg in the no-TD group (Table I). Patients receiving a TD had significantly more laboratory draws than those without a TD during the first 4 months of therapy (Table I). Initial doses were lower in dermatology patients (mean 5.9 mg) than rheumatology patients (mean 8.4 mg, P < .001).Table ICharacteristics and outcomes during first 4 months of therapy by test dose utilizationCharacteristicTest doseNo test doseP value∗On the basis of 2-sample Student t tests for quantitative variables and Fisher's exact test for categorical variables.Specialty Dermatology5619<.001 Rheumatology294Age, y, mean (range)45.3 (10-85)51.3 (6-82).03Sex Male1926.20 Female3987Diagnosis Psoriasis4117<.001 Rheumatoid arthritis166 Other1530Baseline creatinine >1.4 mg/dL Yes011 No58112New grade 2 laboratory abnormality†Tests included were hemoglobin concentration, white blood cell count, absolute neutrophil count, platelet count, and alanine aminotransferase concentration. Yes22.61 No56111New grade ≥3 laboratory abnormality†Tests included were hemoglobin concentration, white blood cell count, absolute neutrophil count, platelet count, and alanine aminotransferase concentration. Yes00NA‡P value was undefined due to a failure to observe any grade 3 abnormalities. No58113Discontinuation due to clinical toxicity§Includes clinical symptoms, such as nausea or hair loss. Yes251 No56108Discontinuation due to laboratory toxicity Yes111 No57112Discontinuation due to any clinical or laboratory toxicity Yes361 No55107No. laboratory draws, mean (range)3.5 (1-9)2.5 (1-5)<.001Initial dose, mg, mean (range)5.4 (5-10)8.3 (5-15)<.001Dosage during first 4 months, mg/wk,¶Calculation of mean dose during the first 4 months can include doses of 0 when methotrexate was discontinued or disrupted. mean (range)12.9 (0.3-19.1)11.6 (2.1-19.1).08NA, Not applicable.∗ On the basis of 2-sample Student t tests for quantitative variables and Fisher's exact test for categorical variables.† Tests included were hemoglobin concentration, white blood cell count, absolute neutrophil count, platelet count, and alanine aminotransferase concentration.‡ P value was undefined due to a failure to observe any grade 3 abnormalities.§ Includes clinical symptoms, such as nausea or hair loss.¶ Calculation of mean dose during the first 4 months can include doses of 0 when methotrexate was discontinued or disrupted. Open table in a new tab NA, Not applicable. There were no deaths or hospitalizations attributed to methotrexate toxicity. Laboratory values obtained 1 week after a TD showed no new grade 3 or 4 abnormalities and prompted only 1 management change, which was discontinuation of methotrexate in 1 patient with mild (grade 1) alanine aminotransferase elevation of uncertain etiology. There were no discontinuations due to hematologic toxicity in either group. Most discontinuations were secondary to nausea or other gastrointestinal symptoms. The incidence of methotrexate discontinuation (any cause) and of grade 2 laboratory abnormalities during the first 4 months of treatment did not significantly differ according to TD use or size of the initial dose (Tables I and II). Our study is limited by sample size and baseline differences between groups in diagnosis and treating specialty.Table IIPatients with grade 2 laboratory abnormalities or discontinuing methotrexate (any cause) during first 4 months of therapy by initial dose receivedCategoryGrade 2 abnormality∗Tests included were hemoglobin concentration, white blood cell count, absolute neutrophil count, platelet count, and alanine aminotransferase concentration.DiscontinuedYesNoYesNoInitial dose, mg 5.0257257 7.5272470 10.0033330 12.50303 15.00202Odds ratio†Odds ratio represents the odds of having a grade 2 abnormality or discontinuing methotrexate for each 1-mg increase in initial dose. Odds ratio was obtained from a logistic regression of having a grade 2 abnormality or discontinuing methotrexate on the initial dose of methotrexate.0.731.11P value‡P value for the odds ratio..32.48∗ Tests included were hemoglobin concentration, white blood cell count, absolute neutrophil count, platelet count, and alanine aminotransferase concentration.† Odds ratio represents the odds of having a grade 2 abnormality or discontinuing methotrexate for each 1-mg increase in initial dose. Odds ratio was obtained from a logistic regression of having a grade 2 abnormality or discontinuing methotrexate on the initial dose of methotrexate.‡ P value for the odds ratio. Open table in a new tab In conclusion, laboratory evaluation 1 week after a methotrexate TD rarely prompted management changes in our patients and can likely be safely omitted in most dermatology and rheumatology patients with normal renal function. We found no significant difference in the incidence of toxicity with initial doses ranging 5-10 mg, and data from clinical trials4Warren R.B. Mrowietz U. von Kiedrowski R. et al.An intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe plaque-type psoriasis (METOP): a 52 week, multicentre, randomized, double-blind, placebo-controlled, phase 3 trial.Lancet. 2017; 389: 528-537Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar suggest that initiation of methotrexate at doses of 15-17.5 mg/wk is associated with a low risk for serious adverse events. Greater caution in dosing and monitoring might be needed in patients who have renal disease or are otherwise at increased risk for methotrexate toxicity." @default.
• W2904271014 created "2018-12-22" @default.
• W2904271014 creator A5010114425 @default.
• W2904271014 creator A5012198646 @default.
• W2904271014 creator A5078026234 @default.
• W2904271014 date "2019-04-01" @default.
• W2904271014 modified "2023-10-17" @default.
• W2904271014 title "Initiation of methotrexate with or without a test dose: A retrospective toxicity study" @default.
• W2904271014 cites W2069350424 @default.
• W2904271014 cites W2121588356 @default.
• W2904271014 cites W2565351134 @default.
• W2904271014 doi "https://doi.org/10.1016/j.jaad.2018.12.015" @default.
• W2904271014 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/30562566" @default.
• W2904271014 hasPublicationYear "2019" @default.
• W2904271014 type Work @default.
• W2904271014 sameAs 2904271014 @default.
• W2904271014 citedByCount "2" @default.
• W2904271014 countsByYear W29042710142021 @default.
• W2904271014 countsByYear W29042710142023 @default.
• W2904271014 crossrefType "journal-article" @default.
• W2904271014 hasAuthorship W2904271014A5010114425 @default.
• W2904271014 hasAuthorship W2904271014A5012198646 @default.
• W2904271014 hasAuthorship W2904271014A5078026234 @default.
• W2904271014 hasBestOaLocation W29042710141 @default.
• W2904271014 hasConcept C126322002 @default.
• W2904271014 hasConcept C143998085 @default.
• W2904271014 hasConcept C151730666 @default.
• W2904271014 hasConcept C167135981 @default.
• W2904271014 hasConcept C2777267654 @default.
• W2904271014 hasConcept C2781059491 @default.
• W2904271014 hasConcept C29730261 @default.
• W2904271014 hasConcept C71924100 @default.
• W2904271014 hasConcept C86803240 @default.
• W2904271014 hasConcept C98274493 @default.
• W2904271014 hasConceptScore W2904271014C126322002 @default.
• W2904271014 hasConceptScore W2904271014C143998085 @default.
• W2904271014 hasConceptScore W2904271014C151730666 @default.
• W2904271014 hasConceptScore W2904271014C167135981 @default.
• W2904271014 hasConceptScore W2904271014C2777267654 @default.
• W2904271014 hasConceptScore W2904271014C2781059491 @default.
• W2904271014 hasConceptScore W2904271014C29730261 @default.
• W2904271014 hasConceptScore W2904271014C71924100 @default.
• W2904271014 hasConceptScore W2904271014C86803240 @default.
• W2904271014 hasConceptScore W2904271014C98274493 @default.
• W2904271014 hasIssue "4" @default.
• W2904271014 hasLocation W29042710141 @default.
• W2904271014 hasLocation W29042710142 @default.
• W2904271014 hasOpenAccess W2904271014 @default.
• W2904271014 hasPrimaryLocation W29042710141 @default.
• W2904271014 hasRelatedWork W1963737685 @default.
• W2904271014 hasRelatedWork W2030215335 @default.
• W2904271014 hasRelatedWork W2053943033 @default.
• W2904271014 hasRelatedWork W2054110146 @default.
• W2904271014 hasRelatedWork W2324013405 @default.
• W2904271014 hasRelatedWork W2516167102 @default.
• W2904271014 hasRelatedWork W3013145321 @default.
• W2904271014 hasRelatedWork W3210359220 @default.
• W2904271014 hasRelatedWork W4234386228 @default.
• W2904271014 hasRelatedWork W4367672288 @default.
• W2904271014 hasVolume "80" @default.
• W2904271014 isParatext "false" @default.
• W2904271014 isRetracted "false" @default.
• W2904271014 magId "2904271014" @default.
• W2904271014 workType "article" @default.