EULAR 2016 | Daily Highlights
MODERATE ALCOHOL CONSUMPTION IS NOT ASSOCIATED WITH SERUM LIVER ABNORMALITIES IN PATIENTS WITH RHEUMATOID ARTHRITIS TAKING METHOTREXATE: DATA FROM THE CLINICAL PRACTICE RESEARCH DATABASE (CPRD)Abstract: THU0078
Authors: J. H. Humphreys1,*, A. Warner1, S. Verstappen1, M. Lunt1, W. Dixon1
Co Authors: 1Arthritis Research UK Centre for Epidemiology, UNIVERSITY OF MANCHESTER, Manchester, United Kingdom
Methotrexate (MTX) is the most commonly prescribed disease modifying anti-rheumatic drug in the treatment of rheumatoid arthritis (RA). Patients taking MTX are advised to restrict their alcohol consumption because of a theoretical hepatotoxic interaction between alcohol and MTX. However data are limited to support this advice.
To quantify the association between alcohol consumption and abnormal serum liver function tests (LFTs) in patients with RA taking MTX, using routinely collected clinical data.
Patients with RA in the Clinical Practice Research Database (CPRD) starting MTX between 1987 and 2011 were studied. Patients were included if they had alcohol consumption details recorded in CPRD and ?6 LFTs per year, indicating adequate monitoring. Patients were grouped by reported weekly alcohol consumption. Crude rates of abnormal LFTs (defined as alanine transaminase or aspartate aminotransferase level ?3 times the upper limit of normal) per 1000 person-years follow up were calculated. Cox proportional hazards models described the association between alcohol consumed and development of abnormal LFTs whilst taking MTX univariately, then adjusting for age and gender. Patients were censored at time of first abnormal LFT, death or the end of follow up (31/12/2011).
8801 patients were included in the study, 6285(71%) female, mean age (SD) was 58(14) years. There were 241 abnormal LFTs in 38000 person-years follow up. There was no difference in rates of abnormal LFTs between drinkers and non-drinkers, adjusted hazard ratio (HR) (95% confidence interval (CI)) 1.12(0.82-1.51). Crude rates of abnormal LFTs appeared to increase with increasing levels alcohol consumption(table 1); similarly when treated as a continuous variable, each increased unit of alcohol consumed was associated with a higher risk of abnormal LFTs, adjusted HR(95%CI) 1.01(1.00-1.02). In the adjusted Cox model, moderate alcohol consumption (?14 units per week) was not associated with a statistically significant risk of developing abnormal LFTs (table 1). There was a non-significant trend to higher HR with higher levels of alcohol consumption, however power was limited in the patients consuming >14 units per week.
|Units of alcohol per week||Number of events§¤||Crude rate (95% CI)||Hazard ratio (95% CI)||Hazard ratio (95% CI)|
|Per 1000 person years||Univariate||Age & gender adjusted|
|1-7||83||5.57 (4.49-6.91)||1.01 (064-1.58)||1.02 (0.65-1.60)|
|8-14||23||5.99 (3.98-9.01)||1.07 (0.60-1.89)||1.15 (0.65-2.06)|
|15-21||11||7.58(4.20-13.68)||1.36 (0.67-2.78)||1.59 (0.76-3.30)|
|21-28||3||8.61(2.78-26.70)||1.51 (0.46-5.03)||1.91 (0.56-6.47)|
|>28||6||9.05(4.07-20.15)||1.60 (0.66-3.92)||1.92 (0.76-4.89)|
|§Event=abnormal LFT ¤Not all patients who were defined as drinkers/non-drinkers had alcohol consumption defined in units|
Conclusions: In patients with RA taking MTX, increasing alcohol consumption is associated with an increased risk of developing abnormal LFTs. The clinical importance of this increased risk may be small when drinking ?14 units per week.
Disclosure of Interest: None declared
Alcohol while taking methotrexate is a common matter for patients on this drug. Current recommendations are generally to withhold alcohol consumption when taking methotrexate because of a potential increase of fatty liver disease and liver damage. This study investigates in a large population cohort whether the combination of methotrexate and alcohol is indeed ‘toxic’. The authors found in fact a dose effect with increasing alcohol intake and abnormal transaminases, however this effect becomes significant only above 14 units of alcohol per week. Overall the effect sizes are small, suggesting that low-to-moderate alcohol consumption is safe when taking methotrexate.
Prof. Dr. Axel Finckh
Geneva University Hospital
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