Cytopenia induced by low-dose methotrexate: An analysis of 433 cases from the French pharmacovigilance database

Methodological Approaches for Analyzing Medication Error Reports in Patient Safety Reporting Systems: A Scoping Review

BACKGROUND

Medication errors (MEs) pose risks to patient safety, resulting in substantial economic costs. To enhance patient safety and learning from incidents, health care and pharmacovigilance organizations systematically collect ME data through reporting systems. Despite the growing literature on MEs in reporting systems, an overview of methods used to analyze them is lacking. The authors aimed to identify, explore, and map available literature on methods used to analyze MEs in reporting systems.

METHODS

The review was based on Joanna Briggs Institute's methodology. The authors systematically searched electronic databases Embase, Medline, CINAHL, Cochrane Central, and other sources (Google Scholar, health care safety and pharmacovigilance centers' websites). Literature published from January 2017 to December 2023 was screened and extracted by two independent researchers.

RESULTS

Among the 59 extracted publications, analyses most often focused on MEs occurring in hospitals (57.6%), included both adult and pediatric patients (79.7%), and used national patent safety monitoring systems as a source (69.5%). We identified quantitative (39.0%), qualitative (11.9%), mixed methods (37.3%), and advanced computerized methods (11.9%). Descriptive quantitative analyses for categorized data were common; however, disproportionality analysis constituted a newer approach to address issues with reporting bias. Free-text data were commonly managed by content analysis, while mixed methods analyzed both categorized and free-text data. In addition, text mining, natural language processing, and artificial intelligence were used in more recent studies.

CONCLUSION

This scoping review uncovered a notable span and diversity in methodologies. Future research should assess the use, applicability, and effectiveness of newer methods such as disproportionality analysis and advanced computerized techniques.

Short-term tolerability and effectiveness of methotrexate monotherapy in adult patients with Crohn's disease: a retrospective study

INTRODUCTION

Immunomodulators remain fundamental for the medical treatment of Crohn's disease (CD). Methotrexate (MTX) is widely used as a second-line immunomodulator; however, there is a lack of recent data on MTX monotherapy among the Asian population with CD. Therefore, in this study, we aimed to investigate the tolerability and clinical outcomes of MTX in Korean patients with CD.

METHODS

A retrospective chart review was performed for CD patients treated with MTX monotherapy or in combination with 5-aminosalicylic acid (5-ASA), at the Asan Medical Center, Seoul, South Korea. The tolerability of MTX monotherapy within 6 months was assessed and the clinical effectiveness of MTX was evaluated based on the Crohn's disease activity index (CDAI).

RESULTS

In total, 85 patients were included, of which 29 (34.1%) discontinued MTX due to intolerability during the follow-up. Adverse events (AEs) were reported in 41 (48.2%) patients. The most common AE was gastrointestinal disorders (17/41) and only one patient experienced a serious AE, a systemic infection that required hospitalization. Among the 56 patients who tolerated MTX within 6 months, 44 (65.9%) showed a clinical response. Moreover, no factor was significantly associated with intolerability. The administration method was the only factor significantly associated with a response to MTX (p = 0.041). The adjusted odds ratio of parenteral injection compared to oral administration was 5.68 (95% confidence interval (CI), 1.07-30.08).

CONCLUSION

In this study, one-third of patients were intolerant to MTX; nonetheless, the response rate was as high as 65.9% among tolerant patients. In addition, no significant factors affected intolerability. In terms of the clinical response, parenteral injection could be better than oral administration.