MONITORING PATIENTS TAKING METHOTREXATE FOR HEPATOTOXICITY - DOES THESTANDARD OF CARE MATCH PUBLISHED GUIDELINES

Background: Controversy persists regarding the validity of published g uidelines for the monitoring of methotrexate-induced hepatotoxicity. O bjective: The purpose of our study was to assess the standard of care by gastroenterologists in the monitoring of methotrexate-induced hepat otoxicity and to compare this standard of care with guidelines in the medical literature. Methods: Gastroenterologists in Connecticut and Ma ssachusetts were surveyed by a mail-in questionnaire that inquired abo ut their protocol for the monitoring of hepatotoxicity in patients tak ing methotrexate. Results: Gastroenterologists in Connecticut and Mass achusetts generally follow the guide lines in the medical literature. Variation in recommendations from the rheumatologic and the dermatolog ic literature is reflected in the practice habits of gastroenterologis ts whose patients are restricted to one particular population. Conclus ion: Long-term follow-up studies should be continued to obtain further data from which to make future recommendations, especially with regar d to the effects of large cumulative doses of methotrexate.