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[Efficacy and safety of treatment with methotrexate, leflunomide, detralex, and their combination of patients with rheumatoid arthritis]

https://arctichealth.org/en/permalink/ahliterature13879
Source
Lik Sprava. 2003 Apr-Jun;(3-4):34-41
Publication Type
Article
Author
S V Shevchuk
M A Stanislavchuk
O O Pentiuk
Source
Lik Sprava. 2003 Apr-Jun;(3-4):34-41
Language
Ukrainian
Publication Type
Article
Keywords
Antirheumatic Agents - adverse effects - therapeutic use
Arthritis, Rheumatoid - drug therapy
Diosmin - adverse effects - therapeutic use
Drug Combinations
Drug Synergism
Drug Therapy, Combination
English Abstract
Female
Hesperidin - adverse effects - therapeutic use
Humans
Isoxazoles - adverse effects - therapeutic use
Male
Methotrexate - adverse effects - therapeutic use
Treatment Outcome
Abstract
A comparative evaluation was done of efficacy and safety of methotrexate, leflunomide singly and of combination of methotrexate with leflunomide or detralex. A total of 189 patients with rheumatoid arthritis (RA) were examined. A 6-month course of controllable treatment was instituted in them. The time-related course of clinical-and-laboratory indices allowed judgement about efficiency of the treatments administered. The functional condition of the patients was assessed according to HAQ. As to efficacy and toxicity, leflunomide (in a dose of 20 mg/daily) was comparable to methotrexate (7.5 to 10 mg/per week) whereas the combination leflunomide-methotrexate has been shown to considerably accelerate regression of clinical symptoms of RA while the use of detralex in the therapeutic complex proved to enhance efficiency of pharmacotherapy with methotrexate and to reduce the incidence rate of its side effects.
PubMed ID
12889354 View in PubMed
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[Incidence and management of ectopic pregnancy in Iceland 2000-2009].

https://arctichealth.org/en/permalink/ahliterature105580
Source
Laeknabladid. 2013 Dec;99(12):565-70
Publication Type
Article
Date
Dec-2013
Author
Áslaug Baldvinsdottir
Jens A Gudmundsson
Reynir Tómas Geirsson
Source
Laeknabladid. 2013 Dec;99(12):565-70
Date
Dec-2013
Language
Icelandic
Geographic Location
Iceland
Publication Type
Article
Keywords
Abortifacient Agents, Nonsteroidal - adverse effects - therapeutic use
Adolescent
Adult
Female
Hospitals, Rural
Hospitals, University
Humans
Iceland - epidemiology
Incidence
Laparoscopy - adverse effects
Length of Stay
Methotrexate - adverse effects - therapeutic use
Obstetric Surgical Procedures - adverse effects
Pregnancy
Pregnancy, Ectopic - diagnosis - epidemiology - therapy
Referral and Consultation
Time Factors
Treatment Outcome
Young Adult
Abstract
Ectopic pregnancy can be life-threatening. Its treatment has changed radically during the last two decades. The study objective was to evaluate incidence and treatment of ectopic pregnancy in the Icelandic population during the decade 2000-2009.
Information was collected about all diagnosed cases, place and method of treatment and admissions. The annual incidence was calculated with reference to number of pregnancies (n/1000), number of women aged 15-44 years (n/10 000) and by 5-year age groups, comparing the periods 2000-2004 and 2005-2009.
The number of ectopic pregnancies during these 10 years was 836, or 444 during the years 2000-2004 and 392 during 2005-2009. The average annual incidence was 15.6/1000 pregnancies and 12.9/10 000 women. There was an annual incidence reduction from 17.3 to 14.1/1000 pregnancies (p
PubMed ID
24345812 View in PubMed
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Intermediate dose methotrexate (IDM) in childhood acute lymphocytic leukaemia in Norway. Report on a national treatment program.

https://arctichealth.org/en/permalink/ahliterature27250
Source
Haematologia (Budap). 1981;14(3):257-63
Publication Type
Article
Date
1981
Author
P J Moe
M. Seip
P H Finne
Source
Haematologia (Budap). 1981;14(3):257-63
Date
1981
Language
English
Publication Type
Article
Keywords
Central Nervous System Diseases - complications - diagnosis - drug therapy
Child
Child, Preschool
Dose-Response Relationship, Drug
Humans
Leukemia, Lymphocytic - complications - drug therapy - mortality
Male
Methotrexate - adverse effects - therapeutic use
Norway
Research Support, Non-U.S. Gov't
Testicular Neoplasms - complications
Abstract
Three courses of intermediate dose methotrexate, 500 mg/m2 at three weekly intervals have been used as part of sanctuary therapy to 95 out of 112 children with acute lymphocytic leukaemia in Norway in the period August 1975 to December 1979. Eight doses of MTX IT were also used for CNS prophylaxis, the first dose was given on the day of admission. As of July 1, 1980, 75 out of 95 (79%) were still in CCR for a median of 36 months (6-57 months).
PubMed ID
6948760 View in PubMed
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Medication errors detected in non-traditional databases: types of errors in methotrexate dosing as listed in four different Danish registers.

https://arctichealth.org/en/permalink/ahliterature275431
Source
Eur J Clin Pharmacol. 2015 Nov;71(11):1375-9
Publication Type
Article
Date
Nov-2015
Author
Helene Perregaard
Jeffrey K Aronson
Kim Dalhoff
Annemarie Hellebek
Source
Eur J Clin Pharmacol. 2015 Nov;71(11):1375-9
Date
Nov-2015
Language
English
Publication Type
Article
Keywords
Antirheumatic Agents - adverse effects - therapeutic use
Databases, Factual - statistics & numerical data
Denmark
Dermatologic Agents - adverse effects - therapeutic use
Humans
Medication Errors - statistics & numerical data
Methotrexate - adverse effects - therapeutic use
Abstract
We have looked for medication errors involving the use of low-dose methotrexate, by extracting information from Danish sources other than traditional pharmacovigilance databases. We used the data to establish the relative frequencies of different types of errors.
We searched four databases for cases involving low-dose methotrexate between 1999 and 2011: the Danish Patient Safety Databases (DPSD), controlled by the Danish National Agency for Patients' Rights and Complaints, the Patient Compensation Association (PCA), the Danish Poison and Information Centre (DPIC), and the online database of the Department for Patient Complaints (DPC). We categorized the place where the error occurred, the processes and types of error involved, the person responsible, and the clinical outcome.
We identified 173 errors. In 109 (63%), either harm resulted or could not be excluded; of these, 26 (15%) resulted in serious harm, including nine deaths (5%); 53 (31%) involved incorrect daily administration; and 107 (62%) involved a dosing error. Sixteen events (9.2%) concerned insufficient or faulty monitoring, with four serious outcomes and two deaths. Prescription errors involving daily rather than weekly administration, by hospital physicians, were most likely to result in serious outcomes, including deaths. The error mechanism was evaluated in 129 events. Action-based errors comprised 50 % and knowledge-based errors 34 %. Action-based errors were more likely to result in completed errors, whereas knowledge-based errors more often resulted in near misses.
The medication errors in this survey were most often action-based (50%) and knowledge-based (34%), suggesting that greater attention should be paid to education and surveillance of medical personnel who prescribe and monitor methotrexate, particularly physicians, who accounted for 40% of the errors.
PubMed ID
26257248 View in PubMed
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Outcomes after anti-rheumatic drug use before and during pregnancy: a cohort study among 150,000 pregnant women and expectant fathers.

https://arctichealth.org/en/permalink/ahliterature126316
Source
Scand J Rheumatol. 2012 May;41(3):196-201
Publication Type
Article
Date
May-2012
Author
K K Viktil
A. Engeland
K. Furu
Author Affiliation
Diakonhjemmet Hospital Pharmacy, Oslo, Norway. kirsten.viktil@diakonsyk.no
Source
Scand J Rheumatol. 2012 May;41(3):196-201
Date
May-2012
Language
English
Publication Type
Article
Keywords
Abnormalities, Drug-Induced - epidemiology - etiology
Adolescent
Adult
Antibodies, Monoclonal, Humanized - adverse effects - therapeutic use
Antirheumatic Agents - adverse effects - therapeutic use
Cohort Studies
Databases, Factual
Drug Utilization Review
Fathers - statistics & numerical data
Female
Humans
Immunoglobulin G - adverse effects - therapeutic use
Isoxazoles - adverse effects - therapeutic use
Male
Methotrexate - adverse effects - therapeutic use
Middle Aged
Mothers - statistics & numerical data
Norway - epidemiology
Pregnancy
Pregnancy outcome
Receptors, Tumor Necrosis Factor - therapeutic use
Registries
Risk factors
Young Adult
Abstract
To study (i) the drug utilization pattern of anti-rheumatic drugs in pregnant women and expectant fathers and (ii) the association between the use of anti-rheumatic drugs during pregnancy and the risk of congenital malformations.
Pregnancies registered in the Medical Birth Registry of Norway (MBRN) were linked to the Norwegian Prescription Database (NorPD) in the period 2004-2007. Prescriptions for anti-rheumatic drugs issued to women 3 months prior to and during pregnancy and to men 3 months prior to conception were identified. Congenital malformations were recorded according to the European Surveillance of Congenital Anomalies (EUROCAT) guidelines.
In 154,976 singleton pregnancies, 1461 of the women (0.9%) and 1198 (0.8%) of the known fathers (150,530) were dispensed anti-rheumatic drugs at least once during the study period: 723 had non-steroidal anti-inflammatory drugs (NSAIDs), 633 prednisolone (CS), 119 sulfasalazine (SASP), 101 azathioprine (AZA), 58 hydroxychloroquine (HQC), 37 etanercept (ETAN), eight methotrexate (MTX), two leflunomide (LEF), and three adalumimab (ADA). Odds ratios (ORs) for malformations in children born of women (w) or men (m) who had received the drugs were OR(w) = 1.06 [95% confidence interval (CI) 0.85-1.32] and OR(m) = 1.19 (95% CI 0.93-1.51), respectively, and for major malformation OR(w) = 1.05 (95% CI 0.79-1.40) and OR(m) = 1.26 (95% CI 0.93-1.71), respectively. None of the children whose mother had received MTX, LEF, ETAN, or ADA were reported to be born with major malformations.
This study revealed no major malformations of the alert drugs MTX, LEF, ETAN, or ADA. Although the numbers are limited, this provides important population-based information to both expectant parents and prescribers.
PubMed ID
22401133 View in PubMed
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Pancytopenia associated with low dose methotrexate therapy. A regional survey.

https://arctichealth.org/en/permalink/ahliterature220708
Source
J Rheumatol. 1993 Jul;20(7):1121-5
Publication Type
Article
Date
Jul-1993
Author
A. al-Awadhi
P. Dale
R J McKendry
Author Affiliation
Rheumatic Disease Unit, Ottawa General Hospital, University of Ottawa, ON, Canada.
Source
J Rheumatol. 1993 Jul;20(7):1121-5
Date
Jul-1993
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Arthritis, Psoriatic - drug therapy
Arthritis, Rheumatoid - drug therapy
Blood Urea Nitrogen
Canada
Creatinine - blood
Dose-Response Relationship, Drug
Female
Folic Acid - therapeutic use
Health Surveys
Humans
Leucovorin - therapeutic use
Male
Methotrexate - adverse effects - therapeutic use
Middle Aged
Pancytopenia - chemically induced - epidemiology - metabolism
Psoriasis - drug therapy
Questionnaires
Risk factors
Trimethoprim-Sulfamethoxazole Combination - therapeutic use
Abstract
To determine which risk factors are associated with serious pancytopenia associated with low dose methotrexate (MTX) therapy.
All Ottawa area rheumatologists, hematologists and dermatologists were surveyed to obtain cases of pancytopenia associated with low dose MTX therapy between 1981 and 1991. Pancytopenia was defined as white blood cells
PubMed ID
8371202 View in PubMed
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Perfusion MRI and SPECT of brain after treatment for childhood acute lymphoblastic leukemia.

https://arctichealth.org/en/permalink/ahliterature18753
Source
Med Pediatr Oncol. 2003 Feb;40(2):88-92
Publication Type
Article
Date
Feb-2003
Author
Eija Pääkkö
Satu Lehtinen
Arja Harila-Saari
Aapo Ahonen
Jukka Jauhiainen
Pentti Torniainen
Juhani Pyhtinen
Marjatta Lanning
Author Affiliation
Department of Diagnostic Radiology, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland. eija.paakko@oulu.fi
Source
Med Pediatr Oncol. 2003 Feb;40(2):88-92
Date
Feb-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Brain - blood supply
Cerebrovascular Circulation
Cerebrovascular Disorders - chemically induced - diagnosis - physiopathology
Child
Child, Preschool
Comparative Study
Cytarabine - adverse effects - therapeutic use
Female
Humans
Iatrogenic Disease
Leukemia, Lymphocytic, Acute - drug therapy
Magnetic Resonance Imaging
Male
Methotrexate - adverse effects - therapeutic use
Technetium Tc 99m Exametazime - diagnostic use
Tomography, Emission-Computed, Single-Photon
Vincristine - adverse effects - therapeutic use
Abstract
BACKGROUND: Treatment of childhood leukemia may cause perfusion defects in the brain observed by SPECT. Perfusion MRI is a novel method to study brain perfusion which has not been used previously in this setting. This study was performed to compare SPECT with perfusion MRI in patients with acute lymphoblastic leukemia (ALL) after treatment. PROCEDURE: Nineteen children or young adults underwent perfusion MRI at the cessation of treatment (n = 9) or 4-8 years after the treatment (n = 10). Seventeen of them also underwent SPECT at the time of MRI (within 0-3 days, n = 14) or a couple of months later (1.5-6 months, n = 3). SPECT images and relative cerebral blood volume (CBV) and cerebral blood flow (CBF) maps from perfusion MRI were analyzed visually. Relative CBV ratios of gray matter to white matter and thalamus to white matter were also calculated from the perfusion MRI. RESULTS: Perfusion MRI did not show any focal perfusion defects, while small defects were observed by SPECT in five of 17 children (29%) in the basal, frontal or temporal areas on the left. No significant differences were observed by perfusion MRI in the relative CBV ratios in the different treatment groups. Time since treatment, age at diagnosis, brain irradiation, or findings in conventional MRI or SPECT did not have any effect on the relative perfusion values either. CONCLUSIONS: SPECT may show small perfusion defects after treatment for childhood leukemia which are not visible by perfusion MRI. The clinical significance or prognosis of these defects is not known.
PubMed ID
12461791 View in PubMed
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Polymorphisms in the ABCB1 gene and effect on outcome and toxicity in childhood acute lymphoblastic leukemia.

https://arctichealth.org/en/permalink/ahliterature272097
Source
Pharmacogenomics J. 2015 Aug;15(4):372-9
Publication Type
Article
Date
Aug-2015
Author
J. Gregers
H. Gréen
I J Christensen
K. Dalhoff
H. Schroeder
N. Carlsen
S. Rosthoej
B. Lausen
K. Schmiegelow
C. Peterson
Source
Pharmacogenomics J. 2015 Aug;15(4):372-9
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Antineoplastic Agents - adverse effects - pharmacokinetics - therapeutic use
Bone Marrow Diseases - chemically induced - epidemiology - genetics
Child
Child, Preschool
Denmark - epidemiology
Drug-Induced Liver Injury - epidemiology - genetics
Genotype
Haplotypes
Humans
Infant
Male
Methotrexate - adverse effects - therapeutic use
P-Glycoproteins - genetics
Polymorphism, Genetic - genetics
Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy - epidemiology - genetics
Predictive value of tests
Recurrence
Risk assessment
Treatment Outcome
Abstract
The membrane transporter P-glycoprotein, encoded by the ABCB1 gene, influences the pharmacokinetics of anti-cancer drugs. We hypothesized that variants of ABCB1 affect outcome and toxicity in childhood acute lymphoblastic leukemia (ALL). We studied 522 Danish children with ALL, 93% of all those eligible. Risk of relapse was increased 2.9-fold for patients with the 1199GA variant versus 1199GG (P=0.001), and reduced 61% and 40%, respectively, for patients with the 3435CT or 3435TT variants versus 3435CC (overall P=0.02). The degree of bone marrow toxicity during doxorubicin, vincristine and prednisolone induction therapy was more prominent in patients with 3435TT variant versus 3435CT/3435CC (P=0.01/PA may be a new possible predictive marker for outcome in childhood ALL.
Notes
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PubMed ID
25582575 View in PubMed
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Survey on the use of methotrexate by pediatric rheumatologists in Canada.

https://arctichealth.org/en/permalink/ahliterature165083
Source
J Rheumatol. 2007 Apr;34(4):818-22
Publication Type
Article
Date
Apr-2007
Author
Gaëlle Chédeville
Rosie Scuccimarri
Ciarán M Duffy
Author Affiliation
Division of Rheumatology, Department of Pediatrics, Montreal Children's Hospital, Quebec, Canada. gaelle.chedeville@muhc.mcgill.ca
Source
J Rheumatol. 2007 Apr;34(4):818-22
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Antirheumatic Agents - adverse effects - therapeutic use
Canada
Drug-Related Side Effects and Adverse Reactions - diagnosis
Health Care Surveys
Humans
Methotrexate - adverse effects - therapeutic use
Pediatrics - statistics & numerical data
Physician's Practice Patterns - statistics & numerical data
Practice Guidelines as Topic
Rheumatology - statistics & numerical data
Abstract
To determine methotrexate (MTX) use and the degree to which Canadian pediatric rheumatologists adhere to the American College of Rheumatology (ACR) guidelines on monitoring for MTX toxicity.
A 20-item questionnaire was e-mailed to 37 pediatric rheumatologists in 17 centers in Canada. A total of 28 (75.7%) responded.
The oral route (PO) of administration was preferred initially by 78.6% in most cases, but for more severe cases, this fell to 42.8%. Those who chose not to start PO used the subcutaneous route (SQ). When PO was initial treatment, a switch to SQ was undertaken because of dose escalation, lack of efficacy, or GI toxicity. An initial mean dose of 0.35-0.5 mg/kg/wk was prescribed by 51.8%. For 75%, the maximum dose was 1 mg/kg/wk (up to 25 mg). Complete blood count, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were determined by 100% at baseline and in followup; albumin and creatinine by 85.7% at baseline, but by only 71.4% and 67.8%, respectively, in followup. After a change in dose, 96.3% requested blood tests at least monthly; this was extended to every 6 to 8 weeks by 78.6% when the dose was stable. Side effects of recurrent nausea and/or vomiting were reported to occur frequently. No severe toxicity, and in particular no case of cirrhosis, was reported. Prophylactic folate supplementation was prescribed by almost all physicians.
Most Canadian pediatric rheumatologists follow ACR guidelines to monitor for MTX toxicity in children with rheumatic diseases who were prescribed MTX. The variation in monitoring and response to toxicity raises the question whether specific pediatric guidelines should be developed.
PubMed ID
17309120 View in PubMed
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10 records – page 1 of 1.