SAT0746-HPR Coffee decreases methotrexate intolerance and increases its compliance in rheumatoid arthritis (RA): a study by rheumatology nurse counsellors
Authors: S.S. Baghel, R.D. Thakran, C. Messi, S. Kapoor, S. Garg, V. Kashyap, Q. Zaheer, A.N. Malaviya
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Methotrexate (MTX) is universally regarded as the 'anchor drug' for the treatment of Rheumatoid Arthritis (RA). Intolerance to MTX is the common cause of non-compliance that leads to poor disease control. The addition of coffee in the treatment regimen for MTX intolerance increases the patient compliance<sup>1</sup> Therefore, awareness about the effect of coffee and counselling for strict adherence to the recommended coffee schedule should be an essential part of patient's education. <h3>Objectives</h3> To assess the effect of coffee on MTX intolerance in patients with RA. <h3>Methods</h3> RA patients attending the Rheumatology clinic, willing to participate in the survey were enrolled in this study.All the patients were asked to take weekly MTX dose along with coffee as per schedule.The coffee schedule advised was as follows: 2 strong cups of coffee early in the morning on the day of the week on which the MTX was schedule. This was repeated in the late evening 1–3 hours before the dose of MTX. The 3rd dose of 2 cups of strong coffee was repeated the next morning. This schedule was repeated every week synchronised with the weekly dose of MTX. All the patients were counselled and explain to follow the coffee schedule. All the information was collected in a pre-designed form. <h3>Results</h3> 600 patients were enrolled in this study. All the patients were treated with the weekly dose of MTX. Among 600 patients 285 (47.5%) did not have any MTX intolerance; 315 (52.5%) had MTX intolerance. In the latter category, 200 (63.5%) patients had minimal intolerance not requiring any intervention. The remaining 115 (36.5%) patients had moderate or severe MTX intolerance. Among these, 52 (45.2%) had complete relief of symptoms with the addition of coffee and were able to continue taking the advised dose of MTX; 17 (14.8%) had partial improvement and continued taking MTX but only with antiemetic; 14 (12.2%) were minimally better but were somehow managing; 14 (12.2%) did not get any relief and discontinued MTX. Another as 18 (15.6%) patients did not agree to take coffee and continued with the symptoms of MTX intolerance. The result of persistent counselling and explaining the coffee schedule with the help of audio-visual aids help the patients to manage MTX intolerance and increases the MTX compliance to ~60% of those with MTX intolerance. If the intolerance symptoms disappeared completely over time, the patients were advised to discontinue coffee unless the patient liked coffee and preferred to continue taking it. <h3>Conclusions</h3> Coffee relieved the symptoms of MTX intolerance in 45.2% and partial relief in 14.8% of the patients. A significant number of patients did not like to take coffee. By intense regular counselling by the specialist rheumatology nurses about the benefits of coffee intake in MTX intolerant patients, helped in decreasing the intolerance and increased its compliance in patients with RA. <h3>Reference</h3> [1] Malaviya AN. Methotrexate intolerance in the treatment of rheumatoid arthritis (RA): effect of adding caffeine to the management regimen. Clin Rheumatology2017Feb;36(2):279–285. <h3>Disclosure of Interest</h3> S. Baghel: None declared, R. Thakran: None declared, C. Messi: None declared, S. Kapoor Consultant for: Advisory board of Novartis, Pfizer, S. Garg Consultant for: Advisory board of Intas, V. Kashyap: None declared, Q. Zaheer: None declared, A. Malaviya Consultant for: Advisory board of IPCA,Janseen,Pfizer,Roche,Zydus,Dr.Reddy,BMS