Thrombocytopenia in patients with rheumatoid arthritis on long-term treatment with low dose methotrexate
Thrombocytopenia in patients with rheumatoid arthritis on long-term treatment with low dose methotrexate
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DOI：
10.1007/bf02230334
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发表时间：
1996-03-01
影响因子：
3.4
通讯作者：
Herborn, G
中科院分区：
文献类型：
--
作者：
Franck, H;Rau, R;Herborn, G
我们回顾了315例类风湿关节炎（RA）患者接受小剂量甲氨蝶呤（MTX）治疗的记录，并评估了导致血小板减少的条件。315例RA患者中有13例血小板计数较低（小于或等于100.000/mm（3））。这些患者的年龄（51 ± 12.6岁）与血小板减少症无关MTX与NSAID合用或多药相互作用引起的血小板减少症，（r = 0.48，p < 0.05）NSAID的停药增加，但MTX治疗的停药增加（r = 0.42，p > 0.05）与MTX周剂量的增加有关（口服12.5 +/- 5 mg），MTX每周剂量与NSAID在同一天联合给药与血小板减少症之间存在显著相关性（r = 0.6，p < 0.05），绝大多数病例（9/13）未停药或仅暂时停药。其余3例患者发生了多种药物相互作用，如果MTX和NSAID合并应用导致血小板减少，并且没有其他多种药物相互作用，则可以安全地对血小板减少患者重新引入低剂量MTX治疗，考虑到NSAID的一半清除时间，优选地，MTX和NSAID应在单独的日期或间隔给予这些风险患者。这种方法避免了血小板减少症的复发，并控制了我们患者中NSAID和MTX的进一步药物相互作用。
We reviewed the records of 315 patients with rheumatoid arthritis (RA) treated with low-dose methotrexate (MTX) and evaluated the conditions contributing to thrombocytopenia. Thirteen out of 315 patients with RA presented with low platelet counts (less than or equal to 100.000/mm(3)). The age of these patients (51 +/- 12.6 years) did not correlate with thrombocytopenia (r = 0.211, p > 0.05).Thrombocytopenia resulted from coadministration of MTX and NSAID or multiple drug interactions, We observed a significant (r = 0.48, p < 0.05) increase of discontinuation of NSAID's but not of MTX therapy (r = 0.42, p > 0.05) with a mounting weekly dosage of MTX (12.5 +/- 5 mg orally), There was a significant correlation between this weekly dosage of MTX coadministered on the same day with NSAID and thrombocytopenia (r = 0.6, p < 0.05).In most cases (9/13) MTX was not or just temporarily withdrawn. Three of the remaining patients had multiple drug interactions, Reintroduction of low dose MTX treatment in patients having had thrombocytopenia could be performed safely, if thrombocytopenia occurred as a result of concomitant application of MTX and NSAID and no other multiple drug interactions, Preferably, MTX and NSAID should be given to these risk patients on separate days or intervals considering half time clearance of NSAIDs. This procedure has avoided the reoccurrence of thrombocytopenia and controlled further drug interactions of NSAIDs and MTX in our patients.