Psoriasis Patients Treated With Methotrexate Have an Increased Risk of Nonmelanoma Skin Cancer: A Systematic Review and Meta-Analysis

Houser, Margaret E. Lang; Stewart, Jacob R.; Brewer, Jerry D.

doi:10.7759/cureus.37174

Cited by 5 publications

(3 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Methotrexate (MTX) is an antifolate therapy, most commonly used in the treatment of rheumatoid arthritis (RA) [ 57 ], psoriasis [ 58 ], inflammatory bowel disease, and a variety of cancers, including lung, breast, and leukemia. The primary mechanism of action involves the inhibition of dihydrofolate reductase (DHFR) which is involved in purine and pyrimidine synthesis [ 57 ], the building blocks for DNA and RNA.…”

Section: Chemotherapy-induced Kidney Injurymentioning

confidence: 99%

Redox Regulation of Nrf2 in Cisplatin-Induced Kidney Injury

Mapuskar,

Pulliam,

Zepeda-Orozco

et al. 2023

Antioxidants

View full text Add to dashboard Cite

Cisplatin, a potent chemotherapeutic agent, is marred by severe nephrotoxicity that is governed by mechanisms involving oxidative stress, inflammation, and apoptosis pathways. The transcription factor Nrf2, pivotal in cellular defense against oxidative stress and inflammation, is the master regulator of the antioxidant response, upregulating antioxidants and cytoprotective genes under oxidative stress. This review discusses the mechanisms underlying chemotherapy-induced kidney injury, focusing on the role of Nrf2 in cancer therapy and its redox regulation in cisplatin-induced kidney injury. We also explore Nrf2's signaling pathways, post-translational modifications, and its involvement in autophagy, as well as examine redox-based strategies for modulating Nrf2 in cisplatin-induced kidney injury while considering the limitations and potential off-target effects of Nrf2 modulation. Understanding the redox regulation of Nrf2 in cisplatin-induced kidney injury holds significant promise for developing novel therapeutic interventions. This knowledge could provide valuable insights into potential strategies for mitigating the nephrotoxicity associated with cisplatin, ultimately enhancing the safety and efficacy of cancer treatment.

show abstract

Section: Chemotherapy-induced Kidney Injurymentioning

confidence: 99%

Redox Regulation of Nrf2 in Cisplatin-Induced Kidney Injury

Mapuskar,

Pulliam,

Zepeda-Orozco

et al. 2023

Antioxidants

View full text Add to dashboard Cite

show abstract

“…It should be noted that haemodialysis does not address the underlying disease but instead prolongs life and allows for the progression of multiple systemic conditions. 3 The choice between PD and HD is crucial for patient outcomes. Studies on survival rates show mixed results, initially favouring PD due to residual renal function (RRF), but as RRF declines, there are potential risks.…”

mentioning

confidence: 99%

Comparative analysis of peritoneal dialysis and hemodialysis for the management of kidney failure: A concise review

Khan,

Siddiqui

2024

J Pak Med Assoc

View full text Add to dashboard Cite

Madam, Chronic kidney disease has a high prevalence, affecting approximately 10-13% of the population. It is a chronic and advancing condition that carries an elevated risk of cardiovascular complications. In the early stages, patients often remain asymptomatic, Treatment options for chronic kidney disease include conservative management for patients with a glomerular filtration rate above 15 ml/minute, and replacement therapies like Hemodialysis (HD), Peritoneal Dialysis (PD), and kidney transplantation1. Peritoneal dialysis involves solute and fluid exchange across the peritoneal membrane, utilizing diffusion, convective transport, and osmosis. Adjusting the flow rate of dialysis solutions optimizes solute and fluid removal, while various techniques enhance these transport characteristics. Peritoneal dialysis has advantages such as home-based therapy, ease of implementation, travel flexibility, lower cost, and suitability for specific patient groups. It allows continuous fluid and solute removal while preserving residual renal function. However, potential disadvantages include infection risks, limited dialysis adequacy, possible malnutrition, concerns about long-term viability, and psychological and fatigue-related issue2. Haemodialysis is a widely used treatment for patients with acute and chronic renal failure, removing waste products through semipermeable membranes. It is commonly employed in medical emergencies like fluid overload and hyperkalemia, as well as various types of renal failure. However, haemodialysis demands substantial dedication and time from both patients and healthcare providers and may not be appropriate for all individuals with renal insufficiency. Treatment-related side effects include cramps, hypotension, issues with blood access, and reactions to dialyzer membranes. It should be noted that hemodialysis does not address the underlying disease but instead prolongs life and allows for the progression of multiple systemic conditions3. The choice between PD and HD is crucial for patient outcomes. Studies on survival rates show mixed results, initially favoring PD due to residual renal function (RRF), but as RRF declines, there are potential risks. HD is generally preferred over PD for diabetic patients, with different risks of bone lesions. PD preserves renal function and improves quality of life as a home-based treatment. An integrated PD/HD program in dialytic centers provides comprehensive care for uremic patients4. In conclusion, the selection between PD and HD depends on factors such as medical suitability, lifestyle, travel considerations, cardiovascular health, and resource availability. PD offers flexibility and independence, while HD can provide more efficient clearance of waste products and toxins from the body. ---Continue

show abstract

“…In recently published studies, researchers have concluded that the use of this drug in psoriatic patients might be doing more harm than good. In a meta-analysis performed by Margaret et al, It was found that psoriasis patients receiving MTX therapy have a 2.8-fold greater likelihood of developing nonmelanoma skin cancer (NMSC) in comparison to those who do not undergo MTX treatment 3 . Moreover, there is evidence that prolonged use of MTX may be associated with an increased probability of developing basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), following a dose-dependent trend 4 .…”

mentioning

confidence: 99%

Revisiting the safety profile: Understanding the link between Methotrexate and skin cancer in psoriasis patients

Maryam Qamar,

Muhammad Salih,

Qamar Uddin Khan

2023

J Pak Med Assoc

View full text Add to dashboard Cite

Madam, Methotrexate (MTX) is an antimetabolite (formerly known as amethopterin) proven t effective in managing autoimmune diseases by suppressing the hyperactive immune response, reducing inflammation, and alleviating associated symptoms. In the case of psoriasis, a chronic autoimmune skin disorder characterized by red, scaly patches on the skin, MTX is among the available treatment options. It is proven beneficial for moderate to severe psoriasis that does not respond adequately to other treatments by reducing the severity and extent of the skin lesions, relieving itching, and improving the overall quality of life. A recent study by Ravi Bharadwaj et al. found that MTX exerts its therapeutic effect on psoriatic skin inflammation by inhibiting the activity of the muropeptide transporter SLC46A21. This mechanism interferes with two key inflammatory responses, namely the NOD1 and NOD2 pathways. It is administered orally, intramuscularly, intravenously, or subcutaneously. Doctors opt for a once-weekly oral dosage, which initiates at a low level to minimize adverse effects. Subsequently, the dosage is incrementally raised to attain the desired efficacy2. Although MTX can be an effective treatment choice, its usage has raised concerns regarding the potential elevation of skin cancer risk. In recently published studies, researchers have concluded that the use of this drug in psoriatic patients might be doing more harm than good. In a meta-analysis performed by Margaret et al., It was found that psoriasis patients receiving MTX therapy have a 2.8-fold greater likelihood of developing non-melanoma skin cancer (NMSC) in comparison to those who do not undergo MTX treatment3. Moreover, there is evidence that prolonged use of MTX may be associated with an increased probability of developing basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), following a dose-dependent trend4. Individuals with psoriasis who may require long-term systemic treatment could face a significantly elevated risk of developing skin cancer. Despite multiple studies confirming the link between MTX and different skin malignancies, its usage remains alarmingly high in treating psoriasis. In resource-limited settings such as Pakistan, this drug is a cost-effective and efficient therapeutic option for managing various forms of psoriasis, including extensive plaque-type psoriasis, acute pustular psoriasis, and erythrodermic psoriasis5. Nevertheless, healthcare workers in Pakistan must prioritize establishing an accurate drug administration plan, to reduce morbidity and mortality rates, as well as the heightened risk of non-melanoma skin cancer (NMSC) among psoriasis patients receiving this treatment.

show abstract

Psoriasis Patients Treated With Methotrexate Have an Increased Risk of Nonmelanoma Skin Cancer: A Systematic Review and Meta-Analysis

Cited by 5 publications

References 34 publications

Redox Regulation of Nrf2 in Cisplatin-Induced Kidney Injury

Redox Regulation of Nrf2 in Cisplatin-Induced Kidney Injury

Comparative analysis of peritoneal dialysis and hemodialysis for the management of kidney failure: A concise review

Revisiting the safety profile: Understanding the link between Methotrexate and skin cancer in psoriasis patients

Contact Info

Product

Resources

About