Pancytopenia secondary to methotrexate therapy in rheumatoid arthritis.
OBJECTIVE
To assess the frequency of methotrexate (MTX)-induced pancytopenia in rheumatoid arthritis (RA).


METHODS
A MEDLINE literature search was conducted to identify articles published during the last 15 years (1980-1995) that presented data on MTX-associated pancytopenia. Two case reports of our own experience are also presented. In addition, articles that examined risk factors associated with MTX-related pancytopenia were identified.


RESULTS
A total of 70 patients with pancytopenia related to MTX therapy were identified (68 reported in the literature, 2 from our own experience). Sixty-one of the patients were described in published case reports, 7 patients were from 5 long-term prospective studies. In many of these cases, predisposing factors for the development of pancytopenia were described. The 5 long-term prospective studies reported toxicity data on patients who had been treated with MTX for at least 13 weeks. A total of 511 patients were included in the prospective trials, yielding an overall incidence of pancytopenia of 1.4% (7 of 511). Of the 70 cases reported, 12 patients died (17%). Most of them had impaired renal function, hypoalbuminemia, concurrent infection, and/or concomitant medication with more than 5 drugs. The minimal cumulative MTX dose leading to fatal pancytopenia was 10 mg, observed in one of our patients.


CONCLUSIONS
Pancytopenia is not an uncommon side effect of low-dose pulse MTX therapy in RA. It can lead to serious complications, including death.
Gutierrez-Ureña
S
S
Louisiana State University School of Medicine at New Orleans, USA.
Molina
J F
JF
García
C O
CO
Cuéllar
M L
ML
Espinoza
L R
LR
D000284:Administration, Oral; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D010198:Pancytopenia / Q000139:chemically induced* / Q000401:mortality; D016019:Survival Analysis
D008727:Methotrexate