Using Electronic Medical Records to Follow Methotrexate Side Effects

Gabriela Schmajuk M.D. M.S. Department of Medicine (Rheumatology) University of California, San Francisco San Francisco VA Medical Center San Francisco, CA 94121MedicalResearch.com Interview with:
Gabriela Schmajuk M.D. M.S.
Department of Medicine (Rheumatology)
University of California, San Francisco
San Francisco VA Medical Center
San Francisco, CA 94121

MedicalResearch.com: What are the main findings of the study?

Dr. Schmajuk: Our main findings were that moderate LFT abnormalities were uncommon
in the first 7 months of methotrexate use among new users, and more
likely to occur in patients with obesity, untreated high cholesterol,
pre-methotrexate LFT elevations, biologic agent use, and lack of folic
acid supplementation.

MedicalResearch.com:  Were any of the findings unexpected?

Dr. Schmajuk: Most of these risk factors have been identified previously, although
never studied in a modern clinical cohort or identified as independent
predictors.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Schmajuk: The most easily modifiable risk factor for LFT elevations is lack of
folic acid supplementation – all patients prescribed methotrexate
should receive concurrent folic acid or folinic acid supplements. In
randomized control trials, folic acid supplements have been shown to
decrease LFT elevations among methotrexate users and and prolong the
use of the drug without compromising the efficacy of methotrexate.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Schmajuk: Future work in this area could develop a prediction rule or program to
identify patients at high risk for MTX-related liver toxicity. In
addition, we should optimize the co-prescription of folic acid along
with methotrexate.

Citation:

Identification of risk factors for elevated transaminases in methotrexate
users through an electronic health record
Schmajuk G, Miao Y, Yazdany J, Boscardin WJ, Daikh DI, Steinman MA.
Arthritis Care Res (Hoboken). 2014 Jan 27. doi: 10.1002/acr.22294
[Epub ahead of print]