Reduced Methotrexate Monitoring Frequency Causes No Adverse Effects - EMJ

Reduced Methotrexate Monitoring Frequency Causes No Adverse Effects

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METHOTREXATE monitoring can be reduced in frequency with no adverse effects, researchers have found. Methotrexate is a conventional synthetic disease-modifying antirheumatic drug commonly used to treat rheumatoid arthritis and other autoimmune conditions by slowing down an overactive immune system and reducing inflammation. Both the British Society for Rheumatology (BSR) and the American College of Rheumatology (ACR) have specific guidelines on methotrexate monitoring, recommending blood tests every 2–3 months for patients taking a stable dose of the drug.  

However, due to the COVID-19 pandemic, these monitoring guidelines have changed, with the BSR now advising less frequent check-ups. At the annual meeting of the BSR, Natasha Wood, a general practice trainee at North Devon District Hospital, UK, presented the results of a patient audit involving an analysis of 824 patients who had been on a stable dose of methotrexate for at least 12 months. This investigation looked at two main patient groups: one group had changed to blood testing from once a month to once every 3 months, and the second had started testing every 5 months instead of every 3 months. Both subsections showed that no harm was caused by this change in monitoring, and abnormal blood results arose from the patients being unwell or symptomatic rather than as a side effect of treatment.  

Reducing the frequency of methotrexate monitoring would prove essential in alleviating the workload and pressure on the healthcare system, as well as aiding patients who might live in remote locations and have limited access to clinical centres. Regarding the importance of these findings, Wood commented: “We wonder whether there’s the possibility of moving towards annual monitoring with good safety netting and patient education for additional blood tests if they are unwell.” She added: “Now may be the time for patient-initiated methotrexate monitoring.”  

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