Comparação da taxa de retenção do metotrexato em pacientes com artrite reumatóide e artrite psoriásica
Tipo
TCC
Data de publicação
2024-11-21
Periódico
Citações (Scopus)
Autores
Melara, Amanda Collere
Ishisaki, Vitor Itiro
Ishisaki, Vitor Itiro
Orientador
Skare, Thelma Larocca
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Título de Volume
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Resumo
INTRODUÇÃO: O metotrexato (MTX) vem sendo usado como droga de primeira escolha tanto para Artrite Reumatoide (AR) quanto para Artrite Psoriásica (APs) devido sua praticidade administrativa e baixo custo. No entanto, os diversos efeitos colaterais causados por esse medicamento, podem estar diretamente relacionados à descontinuidade desse tratamento. Não é sabido se existem diferenças na tolerabilidade desta droga em pacientes com AR e APs. A concomitância da APs com obesidade e síndrome metabólica pode ser um fator que contribuam já que pacientes com APs têm mais esteatose hepática. OBJETIVOS: Estudar e comparar o uso do metotrexato em pacientes com AR e APspor meio da análise do tempo em que o paciente portador de AR e de APs fez uso do MTX, do estudo das causas da suspensão do uso do MTX e da análise da influência ou não do IMC do paciente no tempo de uso desse medicamento. MÉTODOS: Foi realizada uma análise retrospectiva baseada em análise de prontuários de pacientes do Ambulatório de Reumatologia do Hospital Evangélico Mackenzie do Paraná (HUEM), durante o período de 1 de Janeiro de 2000 até 1 de Janeiro de 2010. Foram revisados 102 prontuários de pacientes com AR e 51 com APs que estiveram em uso de MTX e tiveram suspensão do medicamento por qualquer motivo. Foram coletados os seguintes dados: sexo, idade, doença de base, uso de fumo, raça, comorbidades, presença de fator reumatoide, tempo de uso de MTX, dose máxima do MTX, via de administração (oral ou subcutânea), motivo da interrupção, medicamentos concomitantes em uso no momento da interrupção, peso e altura para cálculo de índice de massa corporal, hemoglobina, SGOT, SGPT e creatinina na data da interrupção. RESULTADOS: Nesta amostra, o estudo de pacientes com AR mostrou que 71.5% suspenderam o tratamento por intolerância gástrica, 8.8% por falha terapêutica; e 4.9% por intolerância hepática. Quando os pacientes de AR que suspenderam por intolerância gástrica foram comparados com os demais observou-se que eles tinham menores valores de IMC e maiores valores de SGPT na data de suspenção (p=0,007 e 0,03 respectivamente). Na amostra de APs 45.6% suspenderam por intolerância gástrica, 13.0% por ineficácia; 17.3% por intolerância hepática. Nenhuma peculiaridade foi observada naqueles que suspenderam o medicamento por intolerância gástrica. A comparação de pacientes de AR com APs mostrou que pacientes de AR usaram medicamento por mais tempo (p<0.0001), tinham mais intolerância gástrica (p=0.002) e menos intolerância hepática (p=0.02). Não foi possível correlacionar o IMC com tempo de uso de MTX. (p=ns). CONCLUSÃO: Os dados indicam que os pacientes com AR tendem a utilizar o MTX por mais tempo em comparação com aqueles com APs. O principal motivo de suspensão do medicamento, tanto para pacientes com AR quanto com APs, foi a intolerância gastrointestinal. Ademais, o índice de massa corporal (IMC) não pareceu influenciar significativamente com o tempo de uso, sugerindo que outros fatores, como a tolerância individual ao tratamento, podem ser mais determinantes na adesão e continuidade da terapia.
BACKGROUND: Methotrexate (MTX) has been used as the first-line drug for both Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PsA) due to its administrative convenience and low cost. However, the various side effects caused by this drug, particularly those related to the gastrointestinal system, may be directly linked to the discontinuation of this treatment. Furthermore, more studies are needed on this medication as it is not yet known if there are differences in the tolerability of this drug between patients with RA and PsA. The concomitance of PsA with obesity and metabolic syndrome may be a factor contributing to the lower tolerability of MTX in the treatment of this disease compared to RA, as it accelerates the process of hepatic steatosis. This factor should be studied to enable physicians to make the best therapeutic choice for both diseases in order to prevent treatment interruption by patients. OBJECTIVES: To study and compare the use of methotrexate in patients with Rheumatoid Arthritis and Psoriatic Arthritis by analyzing the duration of MTX use in RA and PsA patients, investigating the reasons for discontinuing MTX use, and examining the influence (or lack thereof) of the patient's BMI on the duration of MTX use. METHODS: A retrospective observational analysis was conducted based on the review of medical records from patients treated at the Rheumatology Outpatient Clinic of the Evangelical Mackenzie Hospital of Paraná (HUEM), covering the period from January 1, 2000, to January 1, 2010. 102 medical records of patients with RA and 51 with PsA who used MTX and discontinued the drug for any reason were reviewed, with a total sample size of 153. The following data were collected in this analysis: gender, age, underlying disease, smoking status, race, comorbidities, presence of rheumatoid factor, duration of MTX use, maximum MTX dose, route of administration (oral or subcutaneous), reason for discontinuation, concomitant medications at the time of discontinuation, weight and height for BMI calculation, hemoglobin, SGOT, SGPT, and creatinine at the time of discontinuation. Patients of both sexes, over 18 years old, with RA (classified according to ACR/EULAR criteria) and Psoriatic Arthritis (classified according to GRAPPA criteria), who used MTX for at least one month and discontinued its use, were included in the study. Patients with other chronic inflammatory diseases, neoplasms, chronic autoimmune or viral hepatitis, HIV, and those with incomplete medical records were excluded. RESULTS: In this sample, the study of patients with RA showed that 71.5% discontinued treatment due to gastric intolerance, 8.8% due to treatment failure; and 4.9% due to hepatic intolerance. When RA patients who were discontinued due to gastric intolerance were compared with the others, it was observed that they had lower BMI values and higher SGPT values on the date of discontinuation (p=0.007 and 0.03, respectively). In the sample of PsA, 45.6% discontinued due to gastric intolerance, 13.0% due to inefficacy; 17.3% due to hepatic intolerance. No peculiarities were observed in those who discontinued the drug due to gastric intolerance. Comparison of RA patients with PsA showed that RA patients used medication for longer (p<0.0001), had more gastric intolerance (p=0.002), and less hepatic intolerance (p=0.02). It was not possible to correlate BMI with duration of MTX use. (p=ns). CONCLUSION: The data indicate that patients with rheumatoid arthritis (RA) tend to use methotrexate (MTX) for a longer period compared to those with psoriatic arthritis (PsA). The main reason for discontinuing the medication, in both RA and PsA patients, was gastrointestinal intolerance, highlighting it as a limiting factor in the prolonged use of MTX. Additionally, body mass index (BMI) did not appear to significantly influence the duration of medication use, suggesting that other factors, such as individual treatment tolerance, may play a more decisive role in adherence and continuity of therapy.
BACKGROUND: Methotrexate (MTX) has been used as the first-line drug for both Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PsA) due to its administrative convenience and low cost. However, the various side effects caused by this drug, particularly those related to the gastrointestinal system, may be directly linked to the discontinuation of this treatment. Furthermore, more studies are needed on this medication as it is not yet known if there are differences in the tolerability of this drug between patients with RA and PsA. The concomitance of PsA with obesity and metabolic syndrome may be a factor contributing to the lower tolerability of MTX in the treatment of this disease compared to RA, as it accelerates the process of hepatic steatosis. This factor should be studied to enable physicians to make the best therapeutic choice for both diseases in order to prevent treatment interruption by patients. OBJECTIVES: To study and compare the use of methotrexate in patients with Rheumatoid Arthritis and Psoriatic Arthritis by analyzing the duration of MTX use in RA and PsA patients, investigating the reasons for discontinuing MTX use, and examining the influence (or lack thereof) of the patient's BMI on the duration of MTX use. METHODS: A retrospective observational analysis was conducted based on the review of medical records from patients treated at the Rheumatology Outpatient Clinic of the Evangelical Mackenzie Hospital of Paraná (HUEM), covering the period from January 1, 2000, to January 1, 2010. 102 medical records of patients with RA and 51 with PsA who used MTX and discontinued the drug for any reason were reviewed, with a total sample size of 153. The following data were collected in this analysis: gender, age, underlying disease, smoking status, race, comorbidities, presence of rheumatoid factor, duration of MTX use, maximum MTX dose, route of administration (oral or subcutaneous), reason for discontinuation, concomitant medications at the time of discontinuation, weight and height for BMI calculation, hemoglobin, SGOT, SGPT, and creatinine at the time of discontinuation. Patients of both sexes, over 18 years old, with RA (classified according to ACR/EULAR criteria) and Psoriatic Arthritis (classified according to GRAPPA criteria), who used MTX for at least one month and discontinued its use, were included in the study. Patients with other chronic inflammatory diseases, neoplasms, chronic autoimmune or viral hepatitis, HIV, and those with incomplete medical records were excluded. RESULTS: In this sample, the study of patients with RA showed that 71.5% discontinued treatment due to gastric intolerance, 8.8% due to treatment failure; and 4.9% due to hepatic intolerance. When RA patients who were discontinued due to gastric intolerance were compared with the others, it was observed that they had lower BMI values and higher SGPT values on the date of discontinuation (p=0.007 and 0.03, respectively). In the sample of PsA, 45.6% discontinued due to gastric intolerance, 13.0% due to inefficacy; 17.3% due to hepatic intolerance. No peculiarities were observed in those who discontinued the drug due to gastric intolerance. Comparison of RA patients with PsA showed that RA patients used medication for longer (p<0.0001), had more gastric intolerance (p=0.002), and less hepatic intolerance (p=0.02). It was not possible to correlate BMI with duration of MTX use. (p=ns). CONCLUSION: The data indicate that patients with rheumatoid arthritis (RA) tend to use methotrexate (MTX) for a longer period compared to those with psoriatic arthritis (PsA). The main reason for discontinuing the medication, in both RA and PsA patients, was gastrointestinal intolerance, highlighting it as a limiting factor in the prolonged use of MTX. Additionally, body mass index (BMI) did not appear to significantly influence the duration of medication use, suggesting that other factors, such as individual treatment tolerance, may play a more decisive role in adherence and continuity of therapy.
Descrição
Palavras-chave
metotrexato , artrite psoriásica e artrite reumatoide , methotrexate , psoriatic arthritis , rheumatoid arthritis