Thrombocytopenia in patients with rheumatoid arthritis on long-term treatment with low dose methotrexate

Franck, H.; Rau, Rolf; Herborn, G.

doi:10.1007/bf02229705

Cited by 38 publications

(29 citation statements)

References 18 publications

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“…The use of TMP-SMX was mentioned as a risk factor for developing bone marrow suppression in one retrospective case-control study 49 and in 17 case reports 18,[50][51][52][53][54][55][56][57][58][59][60][61][62] (Level of evidence 4).…”

Section: Resultsmentioning

confidence: 99%

“…Cytopenia and elevation of liver enzymes were the main reported toxicities. Most reports of cytopenia were attributed to the use of concomitant NSAID or high-dose aspirin (ASA) [18][19][20][21][22][23][24][25][26][27][28][29][30][31] . Other medications, e.g., antibiotics, gastroprotective agents, and antihypertensive drugs, have been noted in case reports.…”

Section: Resultsmentioning

confidence: 99%

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Canadian Recommendations for Use of Methotrexate in Patients with Rheumatoid Arthritis

Katchamart¹,

Bourré‐Tessier²,

Donka³

et al. 2010

J Rheumatol

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Objective.To develop recommendations for the use of methotrexate (MTX) in patients with rheumatoid arthritis.Methods.Canadian rheumatologists who participated in the international 3e Initiative in Rheumatology (evidence, expertise, exchange) in 2007–2008 formulated 5 unique Canadian questions. A bibliographic team systematically reviewed the relevant literature on these 5 topics. An expert committee consisting of 26 rheumatologists from across Canada was convened, and a set of recommendations was proposed based on the results of systematic reviews combined with expert opinions using a nominal group consensus process.Results.The 5 questions addressed drug interactions, predictors of response, strategies to reduce non-serious side effects, variables to assess clinical response, and incorporating patient preference into decision-making. The systematic review retrieved 93 pertinent articles; this evidence was presented to the expert committee during the interactive workshop. After extensive discussion and voting, a total of 9 recommendations were formulated: 2 on drug interactions, 1 on predictors of response, 2 on strategies to reduce non-serious side effects, 3 on variables to assess clinical response, and 1 on incorporating patient preferences into decision-making. The level of evidence and the strength of recommendations are reported. Agreement among panelists ranged from 85% to 100%.Conclusion.Nine recommendations pertaining to the use of MTX in daily practice were developed using an evidence-based approach followed by expert/physician consensus with high level of agreement.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Canadian Recommendations for Use of Methotrexate in Patients with Rheumatoid Arthritis

Katchamart¹,

Bourré‐Tessier²,

Donka³

et al. 2010

J Rheumatol

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“…When used together, TS can increase MTX’s toxicity. Although the exact mechanism is unknown, synergistic folate antagonism, competitive tubular secretion, and displacement from albumin binding site might explain it [8,20–22]. One study pointed out an increase of about 60% of free MTX concentration in blood when used concurrently with TS [15].…”

Section: Discussionmentioning

confidence: 99%

A deadly prescription: combination of methotrexate and trimethoprim-sulfamethoxazole

Hamid

Lashari

Ahsan

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Methotrexate (MTX) is a chemotherapeutic synthetic(s) phase cell cycle inhibitor, and its role has evolved as an immunological agent in autoimmune diseases like rheumatoid arthritis, psoriasis, and systemic lupus erythematosus, etc. Trimethoprim-sulfamethoxazole (TS) is one of the most widely prescribed antibiotics commonly used for urinary tract infections, exacerbations of chronic bronchitis, traveler’s diarrhea, and pneumocystis pneumonia. Both MTX and TS can have significantly overlapping side effects involving dermatologic, renal, and hematological systems, and the combination of these can be deadly. Our case is about the combination of MTX and TS that leads to mucocutaneous ulceration, leukopenia, and renal insufficiency. The purpose of this case is to increase awareness of potentially significant toxicity from the combination of MTX with TS. Abbreviations: MTX: methotrexate; TS: trimethoprim-sulfamethoxazole; ED: emergency department; IV: intravenous; GI: gastrointestinal; NSAIDs: nonsteroidal anti-inflammatory drugs.

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“…However its influence on platelet function i.e. thrombocytopenia, as revealed in different clinical studies, can be a concerning situation for patients using ketoprofen for long term treatment [6,7,17]. The dosage of ketoprofen is 200-300 mg/ /day.…”

Section: Discussionmentioning

confidence: 99%

Effect of Ketoprofen on Lactic Dehydrogenase from Human Platelets

et al. 2014

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Background. In different clinical investigations of thrombocytopenia, ketoprofen was found to be the associated cause. Ketoprofen alone or in combination with other therapeutic regimens leads to a decrease in platelet count. Thrombocytopenia due to ketoprofen use can be a threatening condition to the patients who require uncompromised platelet function. Objectives. In order to establish a mechanism for thrombocytopenia associated with ketoprofen use, the enzyme inhibition effects of ketoprofen on lactic dehydrogenase (LdH) were investigated in this study. LdH is essentially involved in platelet energy production. Material and Methods. LdH isolated from human platelets was subjected to different concentrations of ketoprofen (250, 500, 750, 1000 and 1500 µg/mL) and pyruvate as a substrate (45, 60 and 90 µM/mL) to gain insight into the enzyme inhibition effects for forward reaction. Oxidation of nicotinamide adenine dinucleotide (NadH) was measured at 340 nm to evaluate enzyme activity. enzyme inhibition kinetics were studied via Lineweaver burk plot. Results. Ketoprofen was found to be a competitive inhibitor of LdH in human platelets. 89% of enzyme activity was inhibited by a 1500 µg/mL concentration of the drug and the enzyme inhibition constant was 882 µg/mL. Conclusions. The possible main cause of thrombocytopenia due to ketoprofen use is LdH inhibition in platelets, which are essential for platelet energy metabolism. So patients who require uncompromised platelet function and are receiving ketoprofen in their prescription should be monitored for platelet count and blood clotting (Adv Clin Exp Med 2014, 23, 3, 377-380).

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Thrombocytopenia in patients with rheumatoid arthritis on long-term treatment with low dose methotrexate

Cited by 38 publications

References 18 publications

Canadian Recommendations for Use of Methotrexate in Patients with Rheumatoid Arthritis

Canadian Recommendations for Use of Methotrexate in Patients with Rheumatoid Arthritis

A deadly prescription: combination of methotrexate and trimethoprim-sulfamethoxazole

Effect of Ketoprofen on Lactic Dehydrogenase from Human Platelets

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