Long-Term Routine Laboratory Toxicity Monitoring of Immunomodulatory Drugs in Rheumatoid Arthritis : A Retrospective Cohort Study
Authors' conclusion
Routine laboratory monitoring after 6 months of DMARD use revealed that most very abnormal laboratory results were already clinically anticipated and often occurred after dose escalation, although the cumulative incidence of some less serious abnormal results was quite high.
Study context
- Population
- Patients with rheumatoid arthritis (RA) undergoing long-term routine laboratory toxicity monitoring after at least 6 months of disease-modifying antirheumatic drug (DMARD) use, the Netherlands, July 2008 to April 202059,555 test sets
- Participants
- 4,774 patients
- Outcome
- Cumulative incidence of abnormal and very abnormal laboratory monitoring results (ALT, eGFR, Hb, leukocyte and platelet count)
Methodological detailschart review
- Chart review
Main finding
As reported in the abstract
Cumulative probability of very abnormal laboratory results (5 tests)
At 2 years, range from leukocyte count to estimated glomerular filtration rate (eGFR)
0.2% to 6.6%
At 5 years, range from leukocyte count to eGFR
0.3% to 11%
Observational data: associations, not effects.
Further findings
Clinical context of new very abnormal results (n = 449)
- Occurred after a dose increase
- 6.5%
- Already known or suspected
- 47.7%
- Considered unrelated to DMARD use
- 24.1%
- Did not lead to action
- 35.8%
Cumulative incidence of less serious abnormal results
- eGFR <60 mL/min/1.73 m²
- 39%
- Hemoglobin (Hb) <7.5 mmol/L (females) or <8 mmol/L (males)
- 61%
- As high as
Original publication
Long-Term Routine Laboratory Toxicity Monitoring of Immunomodulatory Drugs in Rheumatoid Arthritis : A Retrospective Cohort Study. Ann Intern Med. Published 26 August 2025. doi:10.
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