![]() ![]() They found that more frequent monitoring, recommended for psoriasis by dermatologists, led to reduced drug survival without differences in severe adverse events compared to a less stringent monitoring strategy. ![]() compared the influence of monitoring on methotrexate survival in psoriasis and psoriatic arthritis patients 6. ![]() ![]() Previous studies addressing safety monitoring have focused on methotrexate. In general, most recommendations advocate measuring a minimum of complete blood count (CBC), creatinine or calculated glomerular filtration rate, and alanine amino transferase (ALT) at baseline and at follow-up 1, 2, 3, 5. In addition, more frequent monitoring should be considered for patients at high risk for toxicity. The 2017 British Society for Rheumatology guideline for monitoring non-biologic DMARD therapy recommendations advise that laboratory tests should be taken every 2 weeks when initiating a new csDMARD until on a stable dose for 6 weeks, and quarterly thereafter 5. However, data on optimal timing of monitoring remains elusive. Overly frequent monitoring should be avoided as it causes burden for patients and healthcare systems. Most of these recommendations, which are based on literature reviews and expert consensus, suggest monitoring for toxicity every 2–4 weeks for the first 3 months and 1–3 monthly thereafter. Currently, multiple national laboratory monitoring recommendations exist 1, 2, 3, 4, 5. Routine laboratory monitoring is recommended for early identification of toxicity during treatment with conventional synthetic disease modifying antirheumatic drugs (csDMARDs). Our computational model predicts ALT elevations after the first follow-up test with good accuracy and can help in optimizing individual testing frequency. Respectively, at first follow-up, in addition to baseline ALT and psoriatic arthritis diagnosis, also ALT change from baseline was identified as an important predictor resulting in a test concordance index of 0.72. Among baseline variables, Lasso model with SIVS predicted subsequent ALT elevations of > 2 × ULN using higher ALT, csDMARD other than methotrexate or sulfasalazine and psoriatic arthritis diagnosis as important predictors, with a concordance index of 0.71 in the test cohort. Primary endpoint was reached in 82 patients (6.9%). Computational models for predicting incident ALT elevations were developed using Lasso Cox proportional hazards regression with stable iterative variable selection (SIVS) and were internally validated against a randomly selected test cohort (1/3 of the data) that was not used for training the models. Primary endpoint was alanine transaminase (ALT) elevation of more than twice the upper limit of normal (ULN) within 6 months after treatment initiation. For rheumatoid arthritis patients, diagnoses and csDMARD initiation/cessation dates were manually confirmed. Baseline and follow-up safety monitoring results were drawn from electronic health records. We identified inflammatory joint disease patients (N = 1196) initiating a csDMARD in Turku University Hospital 2013–2019. We aimed at developing a risk prediction model to individualize laboratory testing at csDMARD initiation. Frequent laboratory monitoring is recommended for early identification of toxicity when initiating conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). ![]()
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