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Methotrexate: prescribing and monitoring practices among the consultant membership of the British Association of Dermatologists.

Collin, B and Srinathan, S K and Finch, T M (2008) Methotrexate: prescribing and monitoring practices among the consultant membership of the British Association of Dermatologists. The British journal of dermatology, 158 (4). pp. 793-800. ISSN 0007-0963. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs

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Official URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-...

Abstract

BACKGROUND

Methotrexate is frequently used in dermatology practice and is potentially toxic. Prescribing and monitoring strategies have evolved over time and many areas of practice remain controversial and without firm evidence base.

OBJECTIVES

To document current U.K. prescribing and monitoring practice and to identify variations in practice.

METHODS

A postal questionnaire was sent, in a single mailshot, in January 2004 to the entire consultant membership (n = 531) of the British Association of Dermatologists.

RESULTS

We received a response rate of 71%. The majority of respondents prescribed for small numbers of patients and 81% reported using a patient information sheet. Almost all monitored full blood count, liver function tests and urea, electrolytes and creatinine, and 71% measured aminoterminal peptide of type III procollagen levels. We identified a wide range of practice in the use of liver biopsy. In terms of adverse events, 12% reported experience of patients developing irreversible liver damage (severity not defined). Forty-nine deaths were reported, of which 18 were due to myelosuppression, six to possible pulmonary fibrosis, two to liver failure in the absence of reported alcohol consumption and four as a consequence of liver biopsy.

CONCLUSIONS

We have documented wide variations in methotrexate prescribing and monitoring practice. We compare reported practice with current guidelines and highlight the importance of monitoring for myelosuppression.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs
Subjects: WR Skin. Dermatology
Divisions: Ambulatory Care > Dermatology
Related URLs:
Depositing User: Sophie Rollason
Date Deposited: 10 Jun 2014 13:15
Last Modified: 10 Jun 2014 13:15
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/204

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