Document Detail

Methotrexate combined with isoniazid treatment for latent tuberculosis is well tolerated in patients with rheumatoid arthritis: experience from an urban arthritis clinic.
MedLine Citation:
PMID:  17711866     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Reactivation of Mycobacterium tuberculosis (TB) is a significant problem with all available tumour necrosis factor (TNF) antagonists when used to treat rheumatoid arthritis (RA), psoriatic arthritis, psoriasis and other inflammatory diseases. Concerns have been raised regarding the appropriate management of patients with latent TB (LTB) exposure (or active TB infection) before initiating TNF antagonists as the safety data of combined treatment with two potentially hepatotoxic medications, methotrexate (MTX) and isoniazid (INH), is lacking. The goal of this study was to investigate the toxicity of MTX and INH treatment in patients with RA before initiating TNF antagonists. METHODS: To investigate the toxicity of MTX and INH treatment in patients with RA we performed a retrospective chart review of patients seen at the Bellevue Hospital Arthritis Clinic in New York City between 2002 and 2006. Forty-four patients who were concomitantly treated with both drugs were included. The primary outcome investigated was increase in liver function tests (LFT). RESULTS: Transient increases in LFT were seen in 11% of patients, but in no case was this more than twice the upper limit of normal values. All abnormal LFT resolved spontaneously without intervention. In addition, no patient has developed signs or symptoms of TB reactivation. CONCLUSIONS: The use of INH for LTB was well tolerated in patients with RA on a background regimen of MTX. While the risks and benefits of all treatment must always be considered, in our experience the additive risk of INH to MTX in terms of hepatotoxicity was low. None the less it is prudent to follow LFT closely on patients taking this combination.
A Mor; C O Bingham; M Kishimoto; P M Izmirly; J D Greenberg; S Reddy; P B Rosenthal
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-08-20
Journal Detail:
Title:  Annals of the rheumatic diseases     Volume:  67     ISSN:  1468-2060     ISO Abbreviation:  Ann. Rheum. Dis.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-19     Completed Date:  2008-04-16     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  0372355     Medline TA:  Ann Rheum Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  462-5     Citation Subset:  IM    
Division of Rheumatology, Department of Medicine, New York University School of Medicine, Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA.
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MeSH Terms
Antirheumatic Agents / adverse effects*,  therapeutic use
Antitubercular Agents / adverse effects
Arthritis, Rheumatoid / complications,  drug therapy*
Drug Interactions
Drug-Induced Liver Injury
Immunosuppressive Agents / adverse effects
Isoniazid / adverse effects*
Liver Function Tests
Methotrexate / adverse effects*,  therapeutic use
Middle Aged
Recurrence / prevention & control
Retrospective Studies
Tuberculosis / complications,  prevention & control*
Tumor Necrosis Factor-alpha / antagonists & inhibitors
Urban Health
Reg. No./Substance:
0/Antirheumatic Agents; 0/Antitubercular Agents; 0/Immunosuppressive Agents; 0/Tumor Necrosis Factor-alpha; 54-85-3/Isoniazid; 59-05-2/Methotrexate

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