Safety of liver function monitoring every 3 months in patients treated with low dose methotrexate

Introduction: The objective of this study was to evaluate the safety of liver transaminases monitoring every 12 weeks in patients with inflammatory connective tissue disorders who aretreated with methotrexate (MTX). Methods: In a retrospective study, the data from the rheumatic patients receiving MTX wereanalyzed. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured at baseline and every 12 weeks. The patients were classified according to their ALTand AST levels as no change, 1-2 times increase, 2-3 times increase, and more than 3 timesincrease in their ALT or AST levels. Based on the physician’s decision on the dose of MTX,the patients were classified into no change in MTX dose, decrease in MTX dose, anddiscontinuation of MTX. Based on the physician’s final decision about the continuation ofMTX, the patients were classified into one of the following groups: continuation of MTXwithout MTX dose reduction; MTX dose reduction; MTX discontinuation due to livercomplication; and MTX discontinuation due to other reasons. Results: A total of 809 patients who were on MTX were included in the study. The meanfollow-up duration and the mean duration of treatment with MTX were 31.22 and 19.76 months, respectively. The mean accumulation dose of MTX was 865.85 mg. Due to theincrease in the level of transaminases in 26 (3.2%) of the patients the dose of MTX wasreduced, and in 9 (1.1%) cases it was temporarily discontinued. During the follow-up of thepatients with elevated transaminases levels, they returned to normal limits in 90 (99.5%) of thepatients; however, in 4 of the cases (0.5%) they remained elevated and MTX wasdiscontinued. The probability of the patients remaining on MTX for 5 years withoutdiscontinuation for liver complications was 98.5%. Conclusion: Liver transaminases monitoring every 12 weeks for MTX treated patients is safe