Alkohol og Methotrexate - en sikker cocktail?

Transkript

1 Alkohol og Methotrexate - en sikker cocktail? Janni Lisander Larsen, projektsygeplejerske, Cand.Cur., Phd. studerende Henrik Nordin M.D. Afdeling for Infektions sygdomme og Reumatologi, Rigshospitalet

2 Baggrund MTX er en af hjørnestenene i behandling af inflammatorisk artrit Et prospektivt studie viste significant lavere lever toxicitet hos Rheumatoid Artrit sammenlignet med Psoriasis Artrit Studier der medtager patientens opfattelse af behandlingen mangler Alkohol drikkes.også når man er på medicin! Department of Infectious Diseases and Rheumatology Copenhagen

3 Alkohol grænser på reumatologiske afdelinger DK Bornholm max. 7 Hjørring max. 7 Gentofte max. 3-7 Viborg max. 3-7 Ålborg max 0-3 Frederiksberg max. 0-3 Rigshospitalet max. 7 Glostrup max. 3-7 Århus max. 7 Esbjerg max. 7 Skanderborg (privat) max. 7 Horsens max. 3-7 Odense max. 0-3 Hillerød max. 14/21 Holbæk max. 7 14/21 Slagelse max. 14/21 Gråsten max 0-3

4 Sundhedsstyrelsens grænser

5 Design Prospectivt kohorte studie med ambulante artrit patienter Behandling med MTX i stabil dosis i mindst 6 mdr. Spørgeskema med follow-up efter 1 år Indsamling af blodprøve svar efter 1 år Ny informations pjece

6 Spørgeskema Alkohol forbrug Oplevelsen af en evt. begrænsning Opfattelsen af MTX Handlemønstre Department of Infectious Diseases and Rheumatology Copenhagen

7 Biokemi Lever funktion målt før intervention Hyppigheden af målinger vurderet af kontakt lægen (4-10 målinger på et år) ALAT-værdier > 2 x ULN blev betragtet som unormal

8 vane+jeg er læge! 2-2% Skræmt+nervøs 6-5% Div. 1 1% Hvad tænker du på, når du hører ordet Methotrexat? Kvalme 11-9% Bivirkninger 7-6% Gift+cellegift 22-19% Stærk medicin 8-7% Langtids biv. 3-3% Nødvendigt 4-3% Kemo+Cytostatika 19-16% Effektiv+positiv 10-9% Konstatering piller mod gigt 16-14% Hårtab 3-3% Graviditet 3-3%

9 Medicin pjece Ny tekst, som lægger vægt på den antiinflammatoriske effekt Følger sundhedsstyrelsens max grænser for alkolhol indtag

10 Kohorten 198 patienter på MTX 108 RA 14 PsA 5 andre 127 (64 %) besvarede spørgeskemaet 10 patienter udfyldte ikke deres skema efter 1 år. Gns dosis MTX 14.7mg/ 14.3 mg ugen

11 Kohorten Alle patients på MTX Diagnose Drop-outs % takkede ja til undersøgelsen 108 RA 14 PsA 5 andre 10 patients (117 til samlet analyse)

12 Har du nogle gange indtaget mere alkohol end tilrådet? Baseline: N= Det er kun sket få gange Indimellem Ja Nej Har aldrig indtaget mere end det tilladte

13 Hvis du har overskredet grænsen, har du da talt med en læge eller sygeplejerske? 80 Baseline: N= Ja Har aldrig indtaget mere end det tilladte Nej

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15 % der indtager alkohol 97,70% 100,00% 90,00% 80,00% 70,00% 60,00% 50,00% 40,00% 30,00% 20,00% 10,00% 0,00% 79,20% Baseline Year 1 Baseline Year 1

16 Forskel i antal genstande Genstande pr uge 10,0 9,0 8,0 7,0 6,0 5,0 3,7 5,5 Baseline Year 1 4,0 3,0 2,0 1,0 0,0 Baseline Year 1 p= 0.027

17 Antal patienter m. forhøjet ALAT (> 2 x ULN) Baseline Year Baseline Year 1 (p=0.993)

18 Korrelation* mellem se-alat og alkohol Alkohol, genstande Baseline Alkohol, genstande 1 year ALAT Baseline p= ALAT 1 year - p= 0.15 Ingen korrelation mellem ALAT og alkohol forbrug gruppe niveau ALAT difference Genstande difference *Persons Correlation

19 Association mellem ALAT og alkohol ALAT Pearson correlation (p= 0.761) Alkohol

20 Følte sig begrænset af alkohol restriktionen p= % 50,00% 45,00% 40,00% 35,00% 30,00% 25,00% 20,00% 15,00% 10,00% 5,00% 0,00% Baseline Year 1 Felt botherd by alcohol restriction 22%

21 Antal patienter som ændrede deres opfattelse af MTX Positive view on MTX Same point of view More Negative

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23 Konklusioner Ændring af alkohol grænser øger indtaget af alkohol, men øger ikke lever påvirkningen, målt ved ALAT Information der understreger den antiinflammatoriske effekt af MTX resulterer I en mere positive attitude overfor medicinen Information til patienter bør gives på grundlag af viden fremfor traditioner

24 THU0516-HP Annual European Congress of Rheumatology, London 2011 Methotrexate And Alcohol - A Compliant Cocktail? RA and PsA patients compliance and beliefs regarding alcohol restrictions and treatment with MTX Janni Lisander Larsen. RN. MSc N. and Henrik Nordin MD. Rigshospitalet, Copenhagen University Hospital, Copenhagen Denmark Conclusions Alcohol is consumed by most patients in the course of MTX treatment. 25% of patients had lowered their intake as a result of medical advise. The majority of patients had at some point exceeded the alcohol limit. 1/3 of the patients felt bothered by the restrictions and were worried regarding the combination of alcohol and MTX Objective To investigate compliance with current alcohol restrictions in our department (7 units/ week) and explore patients beliefs and compliance regarding alcohol restrictions and treatment with MTX. Background MTX is a cornerstone in the treatment of RA and PsA. Hepatic toxicity is still a concern and for safety reasons patients are recommended restricted intake of alcohol. No evidence exsist regarding a safe limit (1,2,3). A study on compliance with MTX treatment shows that patient regard their treatment as important and in general complies with treatment (4). However less is known regarding patients compliance and beliefs regarding alcohol limits in specific. These preliminary results stem from our study on the safety of a nonrestrictive alcohol policy. Imposing unnecessary restrictions on patients should be avoided if possible(5). Methods A self-administered questionnaire was distributed by postal mail to 198 outpatients in a rheumatology department covering demographic data, treatment level and questions regarding patient s personal beliefs about treatment and alcohol restriction. For increased participation non-responders were contacted by postal mail or telephone. All data were entered in a database and descriptive analyses performed. Results 127 patients (64%) completed the questionnaire. Do you sometimes drink alcohol? Yes 14 No Have you felt bothered by the alcohol limit? Yes No Have you felt worried about the combination of MTX and alcohol? Yes No Table 1. Demographics Female / Males no. 97/ 30 Mean age 55/ 56 Diagnosis RA/ PsA 108/ 19 Disease duration (years) 14 Mean MTX dosis (mg/week) 14.9 Treatment duration (years) 1-20 On starting MTX treatment did you reduce your alcohol intake? Yes No No change Have you at some point exceeded the alcohol limit? 66 Yes If the patient had comsumed alcohol above the limit only 9.45% had been in contact with a health person. 82.7% continued MTX treatment even if they knew they would exceed the alcohol limit. The average weekly intake of alcohol in the group of patients were 2 units compared to 7 units in the background population(6). References 47 No 1) Tilling ) Ros ) Salliot ) DeThura ) Rajakulendran ) National Board of Health. Denmark This study is supported by Medac GmbH

25 Targeted information on Methotrexate and lifting alcohol restrictions in patients with RA and PsA is safe and reduces patients negative beliefs. Janni Lisander Larsen, RN, MSc N., Ph.d. student Henrik Nordin, M.D. Annual European Congress of Rheumatology, Madrid Fredag d. 14 juni 2013 This study is supported by Medac GmbH

26 Tak!