Pancytopenia induced by low‐dose methotrexate. A study of the cases reported to the Finnish Adverse Drug Reaction Register from 1991 to 1999

Abstract

Our data show that methotrexate-induced pancytopenia is associated with high mortality especially in cases with significant co-morbidity and concomitant medications.

Etanercept therapy allows the tapering of methotrexate and sustained clinical responses in patients with moderate to severe psoriasis

“…Bone marrow suppression, leading to leukopenia, anemia, thrombocytopenia, and macrocytic anemia, has also been shown to be induced by MTX 3 . The risk of MTX‐induced pancytopenia, which is associated with high mortality, is increased in patients with comorbidity and concomitant medications 4 . In addition, because of the teratogenic properties of MTX, contraception is recommended for both male and female patients 5 .…”

The Risk of Mortality in Patients With Psoriasis

“…12), DEC 2007and idiosyncratic reactions to systemic psoriasis therapies. 6,7 Patients with severe psoriasis who were treated with methotrexate appeared to have a lower risk of mortality than such patients who were not treated with methotrexate, which could be owing to a protective effect of methotrexate on mortality or differences in health status among patients with severe psoriasis who are treated or not treated with methotrexate (ie, confounding by indication). Previous studies [31][32][33] have indicated that successful treatment of inflammatory diseases such as rheumatoid arthritis with methotrexate can lower the overall risk of mortality and that methotrexate may limit the occurrence of cardiovascular events in patients with psoriasis.…”

“…[3][4][5] In addition, certain systemic therapies for psoriasis may rarely be associated with mortality due to chronic cumulative drug toxicity or idiosyncratic reactions, and the disease itself may lead to death in rare instances. [6][7][8][9] Few studies have assessed the risk of mortality in patients with psoriasis, and most have focused on patients hospitalized for treatment. [10][11][12][13] Previous studies from Sweden and Finland [10][11][12] have demonstrated an increased risk in all-cause and/or cause-specific mortality among patients hospitalized for psoriasis compared with the general population.…”

Italian consensus on the recommendations about the use of methotrexate for the treatment of rheumatic diseases with a focus on rheumatoid arthritis: results from the “3E initiative”

“…infezioni) ed in cui la neutropenia si sia risolta spontaneamente, tenuta in considerazione la concomitante associazione con altri fattori di rischio per la tossicità ematologica e somministrando, comunque, acido folico di cui è nota la capacità di ridurre l'incidenza di leucopenia in pazienti affetti da AR in terapia con MTX. Sono stati valutati 594 studi : 12 sono stati inclusi per l'estrazione dei dati (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49). L'incidenza della comparsa di neutropenia in pazienti affetti da AR in trattamento con MTX è risultata variare dallo 0% (47) -1% (47) in caso di concomitante somministrazione di acido folico, al 4,3% (47) -5.4% (49) in assenza di tale associazione.…”