Toxicity profiles of disease modifying anti-rheumatic drugs (DMARDS) in rheumatoid arthritis patients in Karachi. | [Journal of Pakistan Orthopedic Association • 2009]

Author(s):

1. Shakil Baig: Baqai Medical University, Karachi, Pakistan

2. Syed Itaat Zaidi: Baqai Medical University, Karachi, Pakistan

3. Sadaf Noor: Baqai Medical University, Karachi, Pakistan

4. Usman Anwar: Baqai Medical University, Karachi, Pakistan

5. Sadiq Rehman: Baqai Medical University, Karachi, Pakistan

6. Mujahid Humail Syed: Dow University of Health Sciences, Karachi, Pakistan

Abstract:

Objective: The primary objective of the study is to evaluate the adverse events associated with the use of DMARDS in a local sample of Rheumatoid Arthritis (RA ) patients of Karachi. The secondary objective is to compare the toxicities associated with DMARDS monotherapy and combination therapy. Study Design: This is an observational descriptive case series. Materials and Methods: 110 consecutive patient fulfilling 1987 modified ARA-criteria for the diagnosis of RA were screened for disease activity parameters and use of DMARDS. 96 patients were included. Demographic features, clinical disease characteristics, clinical efficacy measures, details of DMARDS type dosages and regimes were noted. Two main DMARDS groups were labelled as ‘monotherapy’ and ‘combination therapy’ groups. The reaction was defined as ‘severe’ if the DMARD was permanently stopped, ‘moderate’ if temporarily stopped or dose adjustment done and ‘mild’ if no change in DMARD was done. All reported adverse reactions were recorded and the data was transferred to excel sheet. Simple percentages and ratios were calculated. Results: Of the 96 patients 14 were males and 82 were females. Mean age was 42 years and mean disease duration was 5.5years. 76% of patients were RF positive. There were total 11 (11.45%) adverse reaction noted of which 7(13.46%) were observed in the combination DMARD group and 4(9%) in the monotherapy group. Severe reactions were noted in 3 (27.27%) all of them in the combination DMARD group. 3 (27.27%) were moderate reactions, 2 of whom in the combination DMARD group and one in monotherapy group. 5 (45.45%) reaction were mild. 3 of them were in monotherapy while 2 were in combination DMARD group. Conclusion: DMARDS in general are well tolerated and have an acceptable toxicity profile under expert hands. Combination DMARD therapy was associated with more frequent as well as more severe toxicities than DMARD monotherapy. Further prospective randomised studies are recommended.

Page(s): 38-43

DOI: DOI not available

Published: Journal: Journal of Pakistan Orthopedic Association, Volume: 21, Issue: 1, Year: 2009

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