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Rahma Anindya Prathitasari
Proportion and factors that associate with incidence of hepatotoxicity in rheumatoid arthritis patients treated with methotrexate in RSCM year 2013-2015
Abstrak :
ABSTRAK
Background Rheumatoid arhtirtis is a chronic autoimmune disease that mainly attacks joints. It may causes joint deformities which leads to lower quality of life of RA patients. RA is treated with metothrexate which inhibiting disease progression. MTX is known for its hepatotoxicity side effect, which is described by an elevation of aspartate aminotransferase and/or alanine aminotransferase beyond the upper normal limit. Factors that may enhance hepatotoxicity are gender, age, cummulative dose of MTX, and duration therapy of MTX. Prevalence of hepatotoxicity caused by MTX therapy in RA patients in Indonesia is still unknown. The objective of this research is to know the proportion of hepatotoxicity and its associations with the factors that may enhance hepatotoxicity caused by MTX therapy in RA patients in RSCM.Method Data about gender, age, cummulative dose and duration therapy of MTX are obtained from 115 RA patients medical records.Result Proportion of hepatotoxicity in RA patients treated with MTX in RSCM is 42.60 percent. Gender, age, cummulative dose and duration therapy of MTX do not significantly enhance hepatotoxicity p>0.05. Conclusion In conclusion gender, age, cummulative dose and duration therapy of MTX do not have association with hepatotoxicity in RA patients treated with MTX.
Jakarta: University of Indonesia School of Medicine, 2018
616 IJR 10:1 (2018)
Artikel Jurnal  Universitas Indonesia Library
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Fara Fauzia
Pengaruh Obesitas Terhadap Tidak Tercapainya Target Terapi Metotreksat Pada Pasien Artritis Reumatoid Di RSUPN Cipto Mangunkusumo Pada Periode Maret 2017-Desember 2021 = Obesity as a Risk Factor of Failure Therapy of Methotrexate in Rheumatoid Arthritis Patients
Abstrak :
Pendahuluan. Artritis Reumatoid (AR) adalah suatu penyakit autoimun yang bersifat sistemik dan kronik yang manifestasi utamanya melibatkan persendian. Tatalaksana AR membutuhkan terapi medikamentosa dan pendekatan gaya hidup. Salah satu tatalaksana AR adalah medikamentosa dengan metotreksat (MTX). Ada banyak faktor yang memengaruhi keberhasilan terapi AR namun di Indonesia belum ditemukan studi yang meneliti obesitas terhadap keberhasilan terapi MTX pada pasien AR di Indonesia. Peneliti ingin mengetahui pengaruh obesitas terhadap ketidakberhasilan terapi MTX monoterapi pada pasien dengan AR. Metode. Studi kohort retrospektif menggunakan data rekam medis Poli Reumatologi Penyakit Dalam, Rumah Sakit Cipto Mangunkusumo (RSCM) pada kurun waktu Maret 2017-Desember 2021. Dilakukan analisis deskriptif untuk melihat karakteristik sampel berdasarkan tiap variabel dan analisis regresi Cox yang dimodifikasi untuk melihat hubungan antara obesitas terhadap ketidakberhasilan terapi MTX. Hasil. Dari 72 subyek, proporsi ketidakberhasilan terapi pada pasien obesitas adalah 57.1% (20/35), sementara pada pasien yang tidak obesitas adalah 37.8% (14/37). Risiko ketidakberhasilan terapi MTX pada pasien dengan obesitas adalah 1,45 kali dibandingkan pasien yang tidak obesitas (RR 1,45; 95% CI 0,76-2,78). Faktor jumlah sendi yang terlibat, faktor RF, faktor C-reactive protein, usia, laju endap darah, jenis kelamin, dan onset awal sakit bukan merupakan faktor perancu pada studi ini. Kesimpulan. Pada studi ini, pasien AR dengan obesitas meningkatkan risiko untuk mengalami ketidakberhasilan terapi MTX dibandingkan pasien AR tanpa obesitas, namun diperlukan studi lebih lanjut menggunakan sampel yang lebih besar untuk meningkatkan kekuatan statistik. ......Introduction. Rheumatoid arthritis (RA)) is a systemic and chronic autoimmune disease which main manifestations involve the joints. AR management requires medical therapy and a lifestyle approach. One of the AR treatments is medication with methotrexate (MTX). There are many factors that influence the success of AR therapy but in Indonesia there has not been found a study that examines obesity on the success of MTX therapy in AR patients in Indonesia. Researchers wanted to know the effect of obesity on the failure of MTX monotherapy in patients with AR Methods. A retrospective cohort study using medical records from the Rheumatology Internal Medicine Polyclinic, Cipto Mangunkusumo Hospital (RSCM) from March 2017 to December 2021. A descriptive analysis was performed to see the sample characteristics based on each variable and a modified Cox regression analysis to see the relationship between obesity and failure of MTX therapy. Results. Of the 72 subjects, the proportion of treatment failure in obese patients was 57.1% (20/35), while in patients who were not obese it was 37.8% (14/37). The risk of MTX treatment failure in obese subjects was 1.45 times that of non-obese patients (RR 1.45; 95% CI 0.76-2.78). Number of joints involved, RF factor, C-reactive protein factor, age, erythrocyte sedimentation rate, gender, and early onset of illness were not confounding factors in this study. Conclusion. In this study, RA patients with obesity have an increased risk of MTX treatment failure MTX compared to RA patients without obesity, but further studies using larger samples are needed to increase statistical power.
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2023
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UI - Tesis Membership  Universitas Indonesia Library
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Cantik Putri Pratiwi Ningrum Djaen
Perubahan kadar beta-HCG sebagai prediktor risiko resistensi metotreksat pada penyakit trofoblas maligna risiko rendah = Changes in beta-HCG levels as predictor for methotrexate resistance risk in low risk gestational trophoblastic neoplasia
Abstrak :
ABSTRAK Latar Belakang: Sekitar 9-33% pasien penyakit trofoblas maligna (PTM) yang diobati dengan kemoterapi agen tunggal akan membutuhkan terapi multi agen karena adanya resistensi terhadap obat lini pertama, termasuk metotreksat (MTX), atau efek samping toksisitas. Hingga saat ini, resistensi terapi lini pertama masih menjadi masalah akibat tingkat identifikasi yang masih rendah. Sebelumnya, belum pernah dilakukan penelitian mengenai kadar Beta-HCG sebagai prediktor resistensi pada pasien PTM risiko rendah. Tujuan: Mengetahui nilai prediktif kadar Beta-HCG untuk risiko resistensi metotreksat pada PTM risiko rendah. Metode: Penelitian ini adalah studi analitik potong lintang menggunakan data rekam medis dari 58 subjek. Subjek adalah semua pasien yang terdiagnosis dengan PTM risiko rendah dan diberikan terapi MTX pada bulan Januari 2011 hingga Desember 2016 di RSUPN Dr. Cipto Mangunkusumo. Pengambilan subjek dilakukan secara konsekutif. Subjek dengan data yang tidak lengkap atau adanya riwayat PTM sebelumnya dieksklusi dari penelitian ini. Hasil: Prevalensi resistensi MTX yaitu 32,8%. Tidak ditemukan asosiasi bermakna antara karakteristik demografik (usia, paritas, pekerjaan, dan pendidikan) ataupun karakteristik klinis (riwayat kehamilan, interval antara kehamilan terakhir dan awal kemoterapi, ukuran tumor, riwayat gagal kemoterapi, lokasi dan jumlah metastasis) dengan resistensi MTX. Ditemukan perbedaan bermakna pada kadar Beta-HCG antara kelompok resistensi dan tidak resistensi pada siklus 4 (p<0,001), 6 (p<0,001), dan 8 (p<0,001). Perbedaan bermakna juga ditemukan pada perubahan kadar Beta-HCG dari awal hingga minggu kedua (p<0,001, AUC 0,8). Cut-off penurunan Beta-HCG sebesar 23% memiliki sensitivitas sebesar 78,9% dan spesifisitas sebesar 74,4% untuk memprediksi resistensi MTX.
ABSTRACT Background: Approximately 9-33% patients with gestational trophoblastic neoplasia (GTN) treated with single agent chemotherapy would need multi agent chemotherapy, whtether due to resistance to first-line therapy, including methotrexate (MTX), or toxic side effect. Currently, resistance to first-line therapy is still a problem due to low identification rate. To this date, there are no studies regarding Beta-HCG level as a MTX resistance predictor for low risk GTN. Purpose: Identify the predictive value of Beta-HCG level for the risk of MTX resistance in low risk GTN. Methods: This was an analytical cross-sectional study using medical records of 58 subjects. Subjects were all patients diagnosed with low risk GTN and given MTX therapy during the period of January 2011 to December 2016 at Cipto Mangunkusumo Hospital. Consecutive sampling was done. Subjects with incomplete data or history of previous GTN were excluded from this study. Results: The prevalence of MTX resistance was 32,8%. No significant association was found between demographic characteristics (age, parity, job, and education) or clinical characteristics (gestational history, interval between last pregnancy and the start of chemotherapy, tumor size, history of chemotherapy failure, location and number of metastasis) and MTX resistance. A significant difference in the level of Beta-HCG between resistance and non-resistance groups were found on cycle 4 (p<0,001), 6 (p<0,001), and 8 (p<0,001). A significant difference was also found in the change of Beta-HCG from the start to the second week of therapy (p<0,001, AUC 0,8). Beta-HCG decrease cut-off of 23% had the sensitivity of 78,9% and specificity of 74,4% to predict MTX resistance. Conclusions: The prevalence of MTX resistance was 32,8% in this study. The decrease in Beta-hCG level from the start to the second week of therapy could be used as a MTX resistance predictor in low risk GTN patients.
Depok: Fakultas Kedokteran Universitas Indonesia, 2018
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UI - Tesis Membership  Universitas Indonesia Library
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Fita Fitrianti
Pengaruh pemberian terapi metotreksat terhadap fungsi kognitif pada pasien artritis reumatoid = Effect of methotrexate on cognitive function in rheumatoid arthritis patients
Abstrak :
Latar Belakang. Artritis reumatoid merupakan penyakit autoimun yang menyebabkan inflamasi kronik artikular dan non-artikular yang  dapat menimbulkan komplikasi berupa gangguan fungsi kognitif. Beberapa studi menunjukkan pemberian terapi Metotreksat mempengaruhi penurunan fungsi kognitif pada pasien AR. Belum ada studi di Indonesia yang menilai hubungan dosis MTX dengan fungsi kognitif pada pasien AR. Tujuan. Penelitian ini bertujuan untuk mengetahui perubahan fungsi kognitif sesudah pemberian terapi MTX selama 3 bulan dan mengetahui hubungan antara dosis MTX dengan fungsi kognitif pada pasien dengan AR. Metode. Desain studi ini adalah kohort prospektif yang melibatkan 39 pasien baru terdiagnosis Artritis reumatoid berusia <60tahun di Poliklinik Reumatologi RSCM. Karakteristik demografi, parameter klinis dan penilaian kognitif didokumentasikan secara lengkap. Penilaian fungsi kognitif dilakukan dengan tes Montreal Cognitive Assessment versi Indonesia (MoCA-Ina) yang sudah tervalidasi. Studi ini menggunakan analisis statistik uji Wilcoxon, analisis bivariat dan korelasi Spearman untuk menganalisis data dengan menggunakan software Stata 15.1. Hasil. Terdapat 28% subjek dengan penurunan fungsi kognitif. Tidak ditemukan perbedaan bermakna terhadap fungsi kognitif global sesudah pemberian MTX selama 3 bulan. Analisis korelasi Spearman menunjukkan adanya korelasi negatif antara kadar dosis MTX dengan domain fungsi memori (r=-0,4,  p =0,01). Kesimpulan. Tidak terdapat perbedaan bermakna terhadap fungsi kognitif global sesudah pemberian MTX selama 3 bulan. Namun, terdapat korelasi negatif antara kadar dosis metotreksat dengan domain fungsi memori ......Background. Rheumatoid arthritis is an autoimmune disease causes chronic articular and non-articular inflammation with cognitive impairment as one of its complication. Several studies have shown that Methotrexate affects the decline of cognitive function in RA patients. There are no studies in Indonesia that have assessed the relationship between MTX and cognitive function in Indonesia. Aim. We aimed to know and to investigate the association between cumulative dose of MTX and cognitive function in patient with RA. Methods. This is a prospective cohort study involving 39 subject with newly diagnosed Rheumatoid arthritis. Demographics characteristics, clinical parameters, and cognitive assessment were documented. Cognitive assessment was assessed based on validated Indonesian version of Montreal Cognitive Assessment (MoCA-Ina) test. This study used Wilcoxon, bivariate analysis and Spearman correlation to analyse the data. Results. A total of 39 patients with RA, 28% were classified as cognitively impaired. There was no significant difference in global cognitive function after administration of MTX in 3 months. Spearman correlation analysis showed negative correlation between cumulative dose of MTX and memory function domain (r=-0.4, p=0.01). Conclusion. There was no significant difference in global cognitive function after administration of MTX in 3 months. Cumulative dose of MTX negatively correlated with memory function domain.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tugas Akhir  Universitas Indonesia Library
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Subandi
Pengaruh pemberian nanokurkumin terhadap ekspresi telomerase, ekspresi NF-kB, dan indeks proliferasi BRDU pada kultur cell line koriokarsinoma BeWo (ATCC CCL-98) = Nanocurcumin effects on telomerase activity, NF-kB expression, and BRDU proliferation index in BeWo choriocarcinoma cell line culture (ATCC CCL-98)
Abstrak :
ABSTRAK
Koriokarsinoma merupakan keganasan yang sangat invasive berasal dari villi plasentra dan trofoblas. Mola invasif dan koriokarsinoma sangat reponsif terhadap kemoterapi dengan angka kesembuhan lebih dari 90 , yang memungkinkan tercapainya kesembuhan tanpa mengganggu fungsi reproduksi. Methotrexate MTX merupakan terapi yang sering digunakan pada beberapa keganasan dan merupakan protokol kemoterapi pada koriokarsinoma, namun MTX memiliki banyak efek samping. Berbagai penelitian pada setengah abad terakhir menunjukan fungsi penting nanokurkumin. Penelitian in vitro dan in vivo menujukkan perannya seperti anti inflamasi, pengeluaran sitokin, anti oksidan dan imunomodulator. Namun, sapai saat ini belum ada penelitian mengenai efek antikanker nanokurkumin pada koriokarsinoma. Penelitian eksperimental sederhana ini menggunakan uji Shapiro-Wilk, uji t sampel bebas, dan uji Anova One Way. Pada penelitianini, kami meneliti dan mebandingkan efek pemberian MTX atau kombinasi dengan nanokurkumin pada berbagai jalur sinyal. Pada penelitian ini, 4 kelompok sel BeWo diberikan kombinasi MTX dan nanokurkumin, 1 kelompok sel BeWo diberikan MTX sebagai control positif, dan 1 kelompok sel BeWo sebagai control negatif. Penelitian ini menunjukkan terdapat penurunan ekspresi telomerase, ekspresi NF- B, dan indeks proliferasi BrdU yang signifikan dengan pemberian kombinasi MTX dan nanokurkumin dibandingkan dengan MTX saja ABSTRACT
Choriocarcinoma is a highly invasive malignant tumor arising from the placental villous and extravillous trophoblast. IM and CCA, which make up the majority of these tumors, are highly responsive to chemotherapy with an overall cure rate exceeding 90 , making it usually possible to achieve cure while preserving reproductive function. Methotrexate is a frequently used for the treatment of several malignancies and is part of the chemotherapy protocols used for choriocarcinoma; however, side-effect are common. Extensive research over the last half century has revealed important functions of nanocurcumin. Invitro and in vivoresearch has shown various activities, such as anti-inflammatory, cytokines release, antioxidant, and immunomodulatory. However, to date no study has been carried out to elucidate its anticancer activity of nanocurcumin in choriocarcinoma. In this study, we investigated and compared the effects of methotrexate alone or in combination with nanocurcumin on various signalling pathway. In this simple experiment stury, we used Saphiro-Wilk test, independent sample t test, and Anova One Way test to analize data. To study the potential cooperative effect of both against, 4 BeWo cell lines were treated with the combination of methotrexate and nanocurcumin, 1 BeWO cell line was treated with methotrexate alone as a positive control, and 1 BeWo cell line as a negative control. This study demonstrated significant reduction of telomerase activity, NF- B expression, and proliferation index BrdU of BeWo cell line treated with a combination of nanocurcumin and methotrexate compared with methotrexate alone. It shows that the effect of nanocurcumin and methotrexate are syngergistic suggest potential for the clinical use of methotrexate in combination with curcumin which will allow effective anticancer effect in choriocarcinoma.
2018
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UI - Tugas Akhir  Universitas Indonesia Library
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Adrian Himawan Singgih
Pengaruh dosis kumulatif metotreksat dan steroid terhadap kejadian osteoporosis sekunder pada anak dan remaja dengan leukemia limfoblastik akut = Influence of methorexate and steroid cumulative doses in secondary osteoporosis in children and adolescents with acute lymphoblastic leukemia
Abstrak :
Latar belakang. Anak dan remaja dengan leukemia limfoblastik akut (LLA) berisiko mengalami osteoporosis sekunder, salah satunya karena pemberian obat kemoterapi metotreksat dan steroid. Saat ini belum terdapat data prevalens osteoporosis sekunder pada anak dengan LLA di Indonesia dan bukti keterkaitan dosis kumulatif metotreksat dan steroid terhadap kejadian osteoporosis sekunder pada anak dengan LLA. Tujuan. Mengetahui ada tidaknya kaitan antara dosis kumulatif metotreksat dan/atau steroid terhadap kejadian osteoporosis sekunder pada anak dan remaja dengan LLA. Metode. Penelitian ini merupakan studi potong lintang terhadap 52 anak dan remaja dengan LLA yang sedang menjalani kemoterapi di Rumah Sakit dr. Cipto Mangunkusumo (RSCM). Pengambilan darah dan foto polos tulang belakang dilakukan untuk menilai parameter kesehatan tulang, serta pemeriksaan dual energy X-ray absorptiometry (DEXA) untuk menilai densitas mineral tulang. Analisis regresi logistik digunakan untuk menganalisis keterkaitan dosis kumulatif metotreksat dan steroid terhadap kejadian osteoporosis sekunder. Hasil. Median usia subyek adalah 10 (7-14) tahun dengan lelaki 54% (n=52). Didapatkan kejadian osteoporosis sekunder 6/52 (11,5%) dan densitas mineral tulang rendah 11/52 (21,2%). Tidak didapatkan kaitan antara dosis kumulatif steroid (adjusted RP 0,474 [0,057-3,935], p = 0,489) dan dosis kumulatif metotreksat (adjusted RP 0,083 [0,006-1,126], p = 0,061)  dengan kejadian osteoporosis sekunder. Pasien berusia di bawah 10 tahun, memiliki kadar vitamin D rendah, dan status prepubertas memiliki kecenderungan mengalami osteoporosis sekunder. Kesimpulan. Tidak didapatkan hubungan yang bermakna secara statistik antara dosis kumulatif steroid dan/atau metotreksat terhadap osteoporosis sekunder pada anak dan remaja dengan LLA. ......Background. Children and adolescents with acute lymphoblastic leukemia (ALL) are at risk of secondary risk, one of which is the administration of chemotherapy drugs (methotrexate and steroids). Currently, there are no data on the prevalence of secondary osteoporosis in children with ALL in Indonesia and evidence about association between methotrexate and steroids with the incidence of secondary osteoporosis with ALL. Objective. To determine whether there is an association between the cumulative dose of methotrexate and/or steroids on the incidence of secondary osteoporosis in children and adolescents with ALL. Methods. This study was a cross-sectional study of 52 children and adolescents with ALL who were undergoing chemotherapy at the Cipto Mangunkusumo Hospital (CMH). Blood sampling and plain radiographs of the spine were performed to assess bone health parameters, as well as dual energy X-ray absorptiometry (DEXA) examination to assess bone mineral density. Logistic regression analysis was used to analyze the association between the cumulative dose of methotrexate and steroids on the incidence of secondary osteoporosis. Result. The median age of the subjects was 10 (7-14) years with 54% men (n=52). The incidence of secondary osteoporosis was 6/52 (11.5%) and low bone mineral density 11/52 (21.2%). There was no association between the cumulative dose of steroids (adjusted PR 1.501 [0.124-18.124], p=0.75) and the cumulative dose of methotrexate (adjusted PR 0.071 [0.005-0.951], p=0.05) and the incidence of secondary osteoporosis. None of the confounding factors (pubertal status, vitamin D levels, income level, age, and sex) were associated with secondary osteoporosis. Patient aged below 10 years old, have prepubertal status, and with low vitamin D serum tends to have osteoporosis more likely. Conclusion. There was no statistically significant relationship between the cumulative dose of steroids and/or methotrexate on secondary osteoporosis in children and adolescents with ALL.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tugas Akhir  Universitas Indonesia Library