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2019, Number 2

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Dermatología Cosmética, Médica y Quirúrgica 2019; 17 (2)

Increased Risk of Severe Mucocutaneous and Hematologic Toxicity Due to the Concomitant Use of Methotrexate and NSAID

Medina AL, Barreda ZL, Estrada AL, Ramos RG, Trejo GJ

Language: Spanish
References: 25
Page: 115-119
PDF size: 188.67 Kb.


ABSTRACT

Methotrexate is the first-line therapy as a disease-modifying antirheumatic drugs in a wide spectrum of inflammatory pathologies. In rare cases, its intake at low doses may be associated with acute severe toxicity, manifested as mucositis, pneumonitis, hepatotoxicity and myelosuppression mainly. Nonsteroidal anti-inflammatory drugs (nsaid), as part of the management of rheumatoid arthritis, when given concomitantly with methotrexate have been shown to increase the risk of toxicity of the latter through different mechanisms. We present the case of a 65-year-old female with a history of rheumatoid arthritis with mucocutaneous and hematological toxicity induced by intake of methotrexate, and debuts when ibuprofen is associated.


REFERENCES

  1. Vashisht D, Muco-cutaneous ulceration induced by low doses of methotrexate, J Dermatol Cosmetol 2018; 2(2):138-9.

  2. Bannwarth B, Péhourcq F, Schaeverbeke T y Dehais J, Clinical pharmacokinetics of low-dose pulse methotrexate in rheumatoid arthritis, Clin Pharmacokinet 1996; 30:194-210.

  3. Seideman P, Beck O, Eksborg S y Wennberg M, The pharmacokinetics of methotrexate and its 7-hydroxy metabolite in patients with rheumatoid arthritis, Br J Clin Pharmacol 1993; 35:409-12.

  4. Singh JA, Saag K, Bridges S, Akl EA, Bannuru RR, Sullivan MC et al., American College of Rheumatology guideline for the treatment of rheumatoid arthritis, Arthritis Rheumatol 2015; 68:1-26.

  5. Smolen J, Landewé R, Breedveld F, Buch M, Burmester G et al., eular recommendations for the management of rheumatoid arthritis with synthetic and biological disease modifying antirheumatic drugs: 2013 update, Ann Rheum Dis 2014; 73:492-509.

  6. Bangert CA y Costner MI, Methotrexate in dermatology, Dermatol Ther 2007; 20(4):216-28.

  7. Kurian A y Haber R, Methotrexate-induced cutaneous ulcers in a nonpsoriatic patient: case report and review of the literature, J Cutan Med Surg 2011; 15(5):275-9.

  8. Yélamos O, Catalá A, Vilarrasa E, Roé E y Puig L, Acute severe methotrexate toxicity in patients with psoriasis: a case series and discussion, Dermatology 2014; 229:306-9.

  9. Preet Singh Y, Aggarwal A, Misra R y Agarwal V, Low-dose methotrexate- induced 388 pancytopenia, Clin Rheumatol 2007; 26:84-7.

  10. Gutiérrez-Urena S, Molina J, García C, Cuéllar M y Espinoza LR, Pancytopenia secondary to methotrexate therapy in rheumatoid arthritis, Arthritis Rheum 1996; 39:272-6.

  11. Wernick R y Smith D, Central nervous system toxicity associated with weekly low-dose methotrexate treatment, Arthritis Rheum 1989; 32:770-5.

  12. Erdbrugger U y Groot K, Is methotrexate nephrotoxic? Dose-dependency, comorbidities and comedication, Z Rheumatol 2011; 70(7):549-52.

  13. Widemann B, Balis F, Kempf-Bielack B, Bielack S, Pratt CB et al., High dose methotrexate-induced nephrotoxicity in patients with osteosarcoma, Cancer 2004; 100(10):2222-32.

  14. Crofford LJ, Use of nsaids in treating patients with arthritis, Arthritis Res Ther 2013; 15:S2.

  15. Levêque D, Santucci R, Gourieux B y Herbrecht R, Pharmacokinetic drug-drug interactions with methotrexate in oncology, Expert Rev Clin Pharmacol 2011; 4:743-50.

  16. Delyon J, Ortonne N, Benayoun E, Moroch J, Wolkenstein P et al., Low dose methotrexate-induced skin toxicity: keratinocyte dystrophy as an histologic marker, J Am Acad Dermatol 2015; 73:484-90.

  17. Romão VC, Lima A, Bernardes M, Canhao H y Fonseca JE, Three decades of low dose methotrexate in rheumatoid arthritis: can we predict toxicity?, Immunol Res 2014; 60:289-310.

  18. Ataide D, Esmanhoto L, Helmer K, Caron I, Campos C et al., Ulceration of psoriatic plaques: cutaneous adverse effects of high dose methotrexate in psoriasis: a report of three cases, An Bras Dermatol 2003; 78: 749-53.

  19. Troeltzsch M, Von Blohn G, Kriegelstein S, Woodlock T, Gassling V et al., Oral mucositis in patients receiving low-dose methotrexate therapy for rheumatoid arthritis: report of 2 cases and literature, Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e28-33.

  20. Svanström H, Lund M, Melbye M y Pastemak B, Concomitant use of low dose methotrexate and nsaid’s and the risk of serious adverse events among patients with rheumatoid arthritis, Pharmacoepidemiolo Drug Saf 2018; 1-9.

  21. Tracy T, Krohn K, Jones D, Bradley JD, Hall SD y Brater DC, The effects of a salicylate, ibuprofen, and naproxen on the disposition of methotrexate in patients with rheumatoid arthritis, Eur J Clin Pharmacol 1992; 42:121-5.

  22. Hall J, Bolina M, Chatterley T y Jamali F, Interaction between low-dose methotrexate and nonsteroidal anti-inflammatory drugs, penicillins, and proton pump inhibitors, Ann Pharmacother 2017; 51:163-178.

  23. DrugDex® Information System, Micromedex Inc, Denver, Colorado 2000, Drug Evaluation Methotrexate.

  24. Borsi J, Sagen E, Romslo I y Moe PJ, Rescue after intermediate and high-dose methotrexate: background, rationale and current practice, Pediatr Hematol Oncol 1990; 7:374-383.

  25. Kepka L, De Lassence A, Ribrag V et al., Successful rescue in a patient with high dose methotrexate-induced nephrotoxicity and acute renal failure, Leuk Lymphoma 1998; 29(1-2):205-9.




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