Severe methotrexate toxicity in elderly patients under diuretics
Objectives To explore the toxicity of low-dose methotrexate (MTX), an uncommon, but life-threatening event.Methods We analysed the presentation, course and risk factors of all patients admitted to the rheumatology ward with severe low-dose MTX toxicity. These patients were compared with patients wit...
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BMJ Publishing Group
2024-02-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/10/1/e003827.full |
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| author | Martin Aringer Nicolai Leuchten Kristine Herrmann Cara Kumar Matthias Kuhn |
| author_facet | Martin Aringer Nicolai Leuchten Kristine Herrmann Cara Kumar Matthias Kuhn |
| author_sort | Martin Aringer |
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| description | Objectives To explore the toxicity of low-dose methotrexate (MTX), an uncommon, but life-threatening event.Methods We analysed the presentation, course and risk factors of all patients admitted to the rheumatology ward with severe low-dose MTX toxicity. These patients were compared with patients without signs of relevant MTX toxicity.Results The 12 patients admitted for MTX toxicity included 7 patients with rheumatoid arthritis, 2 with psoriatic arthritis or psoriasis, 2 patients with giant cell arteritis and 1 with myositis. 1 patient died from infections, while 11 survived under folinic acid administration. All patients suffering from severe MTX toxicity were older than 70 years and were therefore compared with 400 patients who were also older than 70 years, but without MTX toxicity. Of these 400 control patients, the group of patients not on MTX (n=232) had more renal impairment than the group of patients on MTX (n=168). Compared with the 168 MTX-treated patients without toxicity, the 12 patients with life-threatening toxic events had a lower median estimated glomerular filtration rate (eGFR) at the routine visit preceding the acute event (64 (range 32–77) vs 69 (range 8 to >90) mL/min x 1.73, p=0.0251). A multivariate analysis found that patients with toxicity were more frequently treated with diuretics (6/12 vs 24/168), proton pump inhibitors (PPIs; 10/12 vs 70/168) and levetiracetam (2/12 vs 1/168).Conclusions Patients older than 70 years with lower eGFR and being on diuretics, but also on PPIs and levetiracetam, have a significantly higher risk for MTX toxicity. |
| format | Article |
| id | doaj-art-148cd26e87cb46b2af0c0a60dcd22c58 |
| institution | OA Journals |
| issn | 2056-5933 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
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| series | RMD Open |
| spelling | doaj-art-148cd26e87cb46b2af0c0a60dcd22c582025-08-20T01:47:28ZengBMJ Publishing GroupRMD Open2056-59332024-02-0110110.1136/rmdopen-2023-003827Severe methotrexate toxicity in elderly patients under diureticsMartin Aringer0Nicolai Leuchten1Kristine Herrmann2Cara Kumar3Matthias Kuhn4Department of Medicine III and interdisciplinary University Centre for Autoimmune and Rheumatic Entities (UCARE), University Medical Centre and Faculty of Medicine TU Dresden, Dresden, Germany1 Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, GermanyDepartment of Medicine III and interdisciplinary University Centre for Autoimmune and Rheumatic Entities (UCARE), University Medical Centre and Faculty of Medicine TU Dresden, Dresden, GermanyDepartment of Medicine III and interdisciplinary University Centre for Autoimmune and Rheumatic Entities (UCARE), University Medical Centre and Faculty of Medicine TU Dresden, Dresden, GermanyInstitute for Medical Informatics and Biometry (IMB), TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, GermanyObjectives To explore the toxicity of low-dose methotrexate (MTX), an uncommon, but life-threatening event.Methods We analysed the presentation, course and risk factors of all patients admitted to the rheumatology ward with severe low-dose MTX toxicity. These patients were compared with patients without signs of relevant MTX toxicity.Results The 12 patients admitted for MTX toxicity included 7 patients with rheumatoid arthritis, 2 with psoriatic arthritis or psoriasis, 2 patients with giant cell arteritis and 1 with myositis. 1 patient died from infections, while 11 survived under folinic acid administration. All patients suffering from severe MTX toxicity were older than 70 years and were therefore compared with 400 patients who were also older than 70 years, but without MTX toxicity. Of these 400 control patients, the group of patients not on MTX (n=232) had more renal impairment than the group of patients on MTX (n=168). Compared with the 168 MTX-treated patients without toxicity, the 12 patients with life-threatening toxic events had a lower median estimated glomerular filtration rate (eGFR) at the routine visit preceding the acute event (64 (range 32–77) vs 69 (range 8 to >90) mL/min x 1.73, p=0.0251). A multivariate analysis found that patients with toxicity were more frequently treated with diuretics (6/12 vs 24/168), proton pump inhibitors (PPIs; 10/12 vs 70/168) and levetiracetam (2/12 vs 1/168).Conclusions Patients older than 70 years with lower eGFR and being on diuretics, but also on PPIs and levetiracetam, have a significantly higher risk for MTX toxicity.https://rmdopen.bmj.com/content/10/1/e003827.full |
| spellingShingle | Martin Aringer Nicolai Leuchten Kristine Herrmann Cara Kumar Matthias Kuhn Severe methotrexate toxicity in elderly patients under diuretics RMD Open |
| title | Severe methotrexate toxicity in elderly patients under diuretics |
| title_full | Severe methotrexate toxicity in elderly patients under diuretics |
| title_fullStr | Severe methotrexate toxicity in elderly patients under diuretics |
| title_full_unstemmed | Severe methotrexate toxicity in elderly patients under diuretics |
| title_short | Severe methotrexate toxicity in elderly patients under diuretics |
| title_sort | severe methotrexate toxicity in elderly patients under diuretics |
| url | https://rmdopen.bmj.com/content/10/1/e003827.full |
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