Severe Pancytopenia Associated with Low-Dose Methotrexate Therapy for Rheumatoid Arthritis

Abstract

Severe pancytopenia associated with low-dose MTX therapy for rheumatoid arthritis is a potentially serious complication that may occur at any time during therapy. This adverse effect is more likely to occur in patients with renal impairment.

Multiple toxic effects of low-dose methotrexate in a patient treated for psoriasis

“…4 More significant ADRs and severe toxicities such as organ dysfunction (hepatic or renal failure), Stevens-Johnson syndrome (SJS), and severe mucositis can occur but at a much lower frequency. [4][5][6][7][8][9][10] The presence of documented risk factors including renal impairment, folate deficiency, advanced age, alcohol ingestion, hypoalbuminemia, drug-drug interactions, and drug dosing errors will increase the likelihood of a serious ADR. 4 In a recent retrospective review of methotrexate use in clinical practice, 50% of patients reported an adverse event while on therapy, with 32% of those being classified as "significant."…”

“…20 Pancytopenia has been observed in approximately 1.5% of patients taking oral low-dose methotrexate. 10 According to the classification reported by Day et al, 12 pancytopenia may be described as a type A (dosedependent) or type B (idiosyncratic) adverse reaction. Of the known risk factors that may contribute to methotrexate toxicity, renal impairment is recognized as the most common risk factor for low-dose methotrexateinduced pancytopenia.…”

“…Of the known risk factors that may contribute to methotrexate toxicity, renal impairment is recognized as the most common risk factor for low-dose methotrexateinduced pancytopenia. 10 Other risk factors for methotrexate-induced pancytopenia include advanced age, hypoalbuminemia, infection, concomitant drug therapy, and folic acid deficiency. 10 In the three months before admission, our patient had two hospitalizations for acute renal failure and had an SCr of 2.8 mg/dL (baseline of 0.7-0.9 mg/dL) on this admission.…”

Low-Dose Methotrexate Induces Pancytopenia in Rheumatoid Arthritis Patients: Are the Risk Factors Predictors for Physicians?

“…İleri yaş, hipoalbüminemi, yüksek MCV değeri, dehidratasyon, kreatin klirensinin 50 mL/dk altında olması, enfeksiyon, ek ilaç kullanımı, günlük MTX alınması, düşük folik asit düzeyi, folik asit kullanılmaması pansitopeni gelişimi açısından risk faktörleridir (8)(9)(10)(11)(12). Olgularımızın 3'ünde de CrCL< 50 mL/dk iken, hipoalbüminemi, enfeksiyon, ek ilaç kullanımı, mukozit, folik asit almamayı içeren risk faktörleri de olup, sadece 1. olgumuzda MCV yüksekliği mevcuttu.…”

Treatment of Chronic Urticaria

“…There are only several case reports, but the efficacy of methotrexate has not been proven in large controlled studies. There are few literature reports on pulmonary edema, sometimes even fatal, caused by methotrexate in low doses, and on pancytopenia that was observed with higher dose (106)(107)(108). The most important risk factor for methotrexate toxicity is impaired renal function.…”