Comment: Severe Pancytopenia Associated with Methotrexate Therapy for Rheumatoid Arthritis

Leflunomide-Associated Pancytopenia With or Without Methotrexate

“…Methotrexate, which inhibits dihydofolate reductase and interferes with DNA synthesis in actively proliferating cells, is also potentially myelotoxic and has been associated with pancytopenia. 18 The combination of methotrexate with leflunomide is likely to have additive bone marrow toxicity. Despite the product information emphasizing that combined treatment with other DMARDs has not been adequately studied, 1 this case series confirms that concomitant administration with methotrexate occurs in clinical practice and that most reports of pancytopenia are associated with the combination.…”