APIC223882223 - CME/CMLE - Methotrexate-APIC223882223

APIC223882223 - Educational Activity

Pdf Summary

The educational commentary from Julie Hall, provided through the American Society for Clinical Pathology, delves into various aspects of methotrexate (MTX) therapy. Methotrexate, a cytotoxic folic acid antagonist approved by the FDA in 1953, is used to manage severe rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, and severe psoriasis. Its scope has since expanded to various conditions, including some cancers and autoimmune diseases.<br /><br />MTX operates by inhibiting DNA and RNA synthesis, primarily affecting rapidly dividing malignant cells. However, its non-discriminatory cytotoxic nature necessitates careful monitoring and sometimes use of "rescue" therapies like leucovorin and glucarpidase to mitigate side effects and protect healthy cells.<br /><br />Methotrexate is administered in varying doses depending on the condition: low doses for RA and psoriasis, intermediate doses for gestational trophoblastic disease, and high doses for certain cancers. Common side effects are dependent on the dosage but include gastrointestinal issues, liver enzyme elevation, and immunosuppression. Higher doses can lead to severe consequences like bone marrow suppression, renal failure, and hepatic cirrhosis.<br /><br />The risk of adverse effects increases with the use of other medications that impact MTX's renal clearance or compete for protein binding, necessitating stringent monitoring. Pre-treatment evaluation includes history, physical examination, tests for latent infections, kidney function, complete blood count, and liver function tests.<br /><br />Patients on low-dose MTX are monitored every 3 to 6 months, while those on high-dose therapy are monitored more frequently to manage potential toxic effects. Measuring MTX concentrations helps determine the timing and amount of leucovorin needed to counteract its effects.<br /><br />Thus, a meticulous approach involving patient education and regular monitoring enables the effective and safer use of methotrexate in treating serious diseases while minimizing adverse effects.

Keywords

methotrexate

MTX therapy

rheumatoid arthritis

psoriasis

cytotoxic

leucovorin

glucarpidase

adverse effects

patient monitoring

autoimmune diseases