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Monitoring patients taking methotrexate for hepatotoxicity. Does the standard of care match published guidelines?
M Petrazzuoli1, M J Rothe, C Grin-Jorgensen
1Department of Medicine, University of Connecticut School of Medicine, Farmington.
Background:
Controversy persists regarding the validity of published guidelines for the monitoring of methotrexate-induced hepatotoxicity.
Objective:
The purpose of our study was to assess the standard of care by gastroenterologists in the monitoring of methotrexate-induced hepatotoxicity and to compare this standard of care with guidelines in the medical literature.
Methods:
Gastroenterologists in Connecticut and Massachusetts were surveyed by a mail-in questionnaire that inquired about their protocol for the monitoring of hepatotoxicity in patients taking methotrexate.
Results:
Gastroenterologists in Connecticut and Massachusetts generally follow the guidelines in the medical literature. Variation in recommendations from the rheumatologic and the dermatologic literature is reflected in the practice habits of gastroenterologists whose patients are restricted to one particular population.
Conclusion:
Long-term follow-up studies should be continued to obtain further data from which to make future recommendations, especially with regard to the effects of large cumulative doses of methotrexate.