Abhishek Abhishek
Risk-stratified monitoring for sulfasalazine toxicity: prognostic model development and validation
Abhishek, Abhishek; Grainge, Matthew; Card, Tim; Williams, Hywel C; Taal, Maarten W; Aithal, Guruprasad P; Fox, Christopher P; Mallen, Christian D; Stevenson, Matthew D; Nakafero, Georgina; Riley, Richard
Authors
Matthew Grainge
Tim Card
Hywel C Williams
Maarten W Taal
Guruprasad P Aithal
Christopher P Fox
Christian Mallen c.d.mallen@keele.ac.uk
Matthew D Stevenson
Georgina Nakafero
Richard Riley
Abstract
Background: Sulfasalazine-induced cytopenia, nephrotoxicity and hepatotoxicity is uncommon during long-term treatment. Some guidelines recommend 3 monthly monitoring blood tests indefinitely during long-term treatment while others recommend stopping monitoring after 1 year. To rationalise monitoring, we developed and validated a prognostic model for clinically significant blood, liver or kidney toxicity during established sulfasalazine treatment.
Design: Retrospective cohort study.
Setting: UK primary care. Data from Clinical Practice Research Datalink Gold and Aurum formed independent development and validation cohorts.
Participants: Age ≥18 years, new diagnosis of an inflammatory condition and sulfasalazine prescription.
Study period: 1 January 2007 to 31 December 2019.
Outcome: Sulfasalazine discontinuation with abnormal monitoring blood-test result.
Analysis: Patients were followed up from 6 months after first primary care prescription to the earliest of outcome, drug discontinuation, death, 5 years or 31 December 2019. Penalised Cox regression was performed to develop the risk equation. Multiple imputation handled missing predictor data. Model performance was assessed in terms of calibration and discrimination.
Results: 8936 participants were included in the development cohort (473 events, 23 299 person-years) and 5203 participants were included in the validation cohort (280 events, 12 867 person-years). Nine candidate predictors were included. The optimism adjusted R2D and Royston D statistic in the development data were 0.13 and 0.79, respectively. The calibration slope (95% CI) and Royston D statistic (95% CI) in validation cohort was 1.19 (0.96 to 1.43) and 0.87 (0.67 to 1.07), respectively.
Conclusion: This prognostic model for sulfasalazine toxicity uses readily available data and should be used to risk-stratify blood-test monitoring during established sulfasalazine treatment.
Citation
Abhishek, A., Grainge, M., Card, T., Williams, H. C., Taal, M. W., Aithal, G. P., Fox, C. P., Mallen, C. D., Stevenson, M. D., Nakafero, G., & Riley, R. (2024). Risk-stratified monitoring for sulfasalazine toxicity: prognostic model development and validation. RMD Open, 10(1), Article e003980. https://doi.org/10.1136/rmdopen-2023-003980
Journal Article Type | Article |
---|---|
Acceptance Date | Jan 30, 2024 |
Online Publication Date | Mar 7, 2024 |
Publication Date | Mar 7, 2024 |
Deposit Date | Mar 19, 2024 |
Publicly Available Date | Mar 19, 2024 |
Journal | RMD Open |
Electronic ISSN | 2056-5933 |
Publisher | BMJ Publishing Group |
Peer Reviewed | Peer Reviewed |
Volume | 10 |
Issue | 1 |
Article Number | e003980 |
DOI | https://doi.org/10.1136/rmdopen-2023-003980 |
Keywords | arthritis, psoriatic, arthritis, rheumatoid, sulfasalazine, treatment |
Public URL | https://keele-repository.worktribe.com/output/775955 |
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Risk-stratified monitoring for sulfasalazine toxicity: prognostic model development and validation
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This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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