Treatment with ARAVA was associated with elevations of liver enzymes, primarily ALT and AST, in a significant number of patients; these effects were generally reversible. Most transaminase elevations were mild ( ≤ 2-fold ULN) and usually resolved while continuing treatment. Marked elevations ( > 3-fold ULN) occurred infrequently and reversed with dose reduction or discontinuation of treatment. Table 1 shows liver enzyme elevations seen with monthly monitoring in clinical trials Trial 1 and Trial 2. It was notable that the absence of folate use in Trial 3 was associated with a considerably greater incidence of liver enzyme elevation on methotrexate.
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If I BB’r really wanted to get crazy he might combine 2 injectables and maybe 2 orals (most BB’rs in that day used only one oral at a time)…and the total dosage might reach 1,500 mg weekly. However, this was not the norm and was considered excessive by most. I am sure at least a few people reading article this will call bullshit because they know of someone who used more, but like I said, there have always been guys who have pushed the dosing envelope in their generation. However, these men do not adequately represent the average BB’r of their era. They are the exception, not the rule.