Reply: Methotrexate neurotoxicity due to drug interactions: an inadequate folinic acid effect

Forster, Victoria J.; Delft, Frederik W. van; Baird, Susan; Mair, Shona; Skinner, Roderick; Halsey, Christina

doi:10.1007/s00280-017-3270-4

Cited by 2 publications

(3 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, they proposed that neurotoxicity was inversely correlated with leucovorin dose 22,23 . The method of how to adjust the leucovorin dose, especially in patients with severe toxicities, is still controversial in clinical practice 24 …”

Section: What Is Known and Objectivementioning

confidence: 99%

“…22,23 The method of how to adjust the leucovorin dose, especially in patients with severe toxicities, is still controversial in clinical practice. 24 At present, various methods for calculating leucovorin doses in different tumour types have been proposed, including empirical calculations based on MTX plasma concentrations, 25 the Bleyer nomogram, 14 and other methods. 26 Nonetheless, leucovorin rescue protocols differ greatly across tumour types and medical institutions.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Leucovorin (folinic acid) rescue for high‐dose methotrexate: A review

Jiang

Mei

Zhao

2022

Clinical Pharmacy Therapeu

View full text Add to dashboard Cite

High‐dose methotrexate (HDMTX) is active against various malignancies; it possesses serious toxicities and is associated with patient characteristics, dosage regimens, comedications, and physiological status. There are many strategies to overcome HDMTX‐induced toxicities, such as hydration, alkalization, leucovorin rescue, and haemodialysis. Leucovorin rescue is a cornerstone for toxicity prevention in HDMTX treatment. However, the leucovorin dose adjustment and the existence of leucovorin overrescue are still controversial. At present, various methods for calculating leucovorin doses in different tumour types have been proposed, including empirical calculations based on MTX plasma concentration, the Bleyer nomogram, and other methods. Nonetheless, leucovorin rescue protocols differ greatly across tumour types and medical institutions. Further studies are needed to investigate the optimal dosage regimen for leucovorin rescue in various tumours using HDMTX.

show abstract

Section: What Is Known and Objectivementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Leucovorin (folinic acid) rescue for high‐dose methotrexate: A review

Jiang

Mei

Zhao

2022

Clinical Pharmacy Therapeu

View full text Add to dashboard Cite

show abstract

“…Increased toxicity after HD-MTX has been attributed to the use of inadequate FA doses and to a delay in commencing FA rescue [6]. However, the minimum duration and dose of FA rescue needed to prevent excess toxicity after HD-MTX remains unclear [7]. Furthermore, the use of higher doses of FA after HD-MTX has been associated with an increased risk of leukemic relapse [8,9].…”

Section: Introductionmentioning

confidence: 99%

Reduced dose folinic acid rescue after rapid high-dose methotrexate clearance is not associated with increased toxicity in a pediatric cohort

Niinimäki

Aarnivala

Banerjee

et al. 2021

Support Care Cancer

View full text Add to dashboard Cite

Purpose Low doses of folinic acid (FA) rescue after high-dose methotrexate (HD-MTX) have been associated with increased toxicity, whereas high doses may be related to a decreased antileukemic effect. The optimal dosage and duration of FA rescue remain controversial. This study was designed to investigate, whether a shorter duration of FA rescue in the setting of rapid HD-MTX clearance is associated with increased toxicity. Methods We reviewed the files of 44 children receiving a total of 350 HD-MTX courses during treatment for acute lymphoblastic leukemia according to the NOPHO ALL-2000 protocol. Following a 5 g/m2 HD-MTX infusion, pharmacokinetically guided FA rescue commenced at hour 42. As per local guidelines, the patients received only one or two 15 mg/m2 doses of FA in the case of rapid MTX clearance (serum MTX ≤ 0.2 μmol/L at hour 42 or hour 48, respectively). Data on MTX clearance, FA dosing, inpatient time, and toxicities were collected. Results Rapid MTX clearance was observed in 181 courses (51.7%). There was no difference in the steady-state MTX concentration, nephrotoxicity, hepatotoxicity, neutropenic fever, or neurotoxicity between courses followed by rapid MTX clearance and those without. One or two doses of FA after rapid MTX clearance resulted in a 7.8-h shorter inpatient time than if a minimum of three doses of FA would have been given. Conclusion A pharmacokinetically guided FA rescue of one or two 15 mg/m2 doses of FA following HD-MTX courses with rapid MTX clearance results in a shorter hospitalization without an increase in toxic effects.

show abstract

Reply: Methotrexate neurotoxicity due to drug interactions: an inadequate folinic acid effect

Cited by 2 publications

References 9 publications

Leucovorin (folinic acid) rescue for high‐dose methotrexate: A review

Leucovorin (folinic acid) rescue for high‐dose methotrexate: A review

Reduced dose folinic acid rescue after rapid high-dose methotrexate clearance is not associated with increased toxicity in a pediatric cohort

Contact Info

Product

Resources

About