title: Pancytopenia induced by low-dose methotrexate. A study of the cases reported to the Finnish Adverse Drug Reaction Register From 1991 to 1999.
abstract: OBJECTIVE
  To study cases of low-dose methotrexate-induced pancytopenia with special reference to clinical outcome and factors predisposing to bone marrow suppression.
  
  
  METHODS
  Patient files of 14 cases of methotrexate-induced pancytopenia reported to the National Agency for Medicines in Finland from 1991 to 1999 were reviewed. A review of four additional cases was included.
  
  
  RESULTS
  Of the 18 patients (median age 72 years), 12 had rheumatoid arthritis, one psoriatic arthritis, five psoriasis without arthritis, and one pemphigus erythematosus. Major co-morbidity was recorded in 12 patients, and 16 patients used significant concomitant drugs. Eight patients had a mildly or moderately elevated serum creatinine concentration. In every patient the occurrence of cytopenia was abrupt. Eight patients (44%) died, and the most frequent cause of death was infection.
  
  
  CONCLUSIONS
  Our data show that methotrexate-induced pancytopenia is associated with high mortality especially in cases with significant co-morbidity and concomitant medications.
authors.affiliation: Department of Medicine, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland. tapio.kuitunen@kolumbus.fi
authors.forename: T
authors.initials: T
authors.lastname: Kuitunen
authors.forename: J
authors.initials: J
authors.lastname: Malmström
authors.forename: E
authors.initials: E
authors.lastname: Palva
authors.forename: T
authors.initials: T
authors.lastname: Pettersson
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000368:Aged; D001853:Bone Marrow / Q000187:drug effects / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D005387:Finland / Q000453:epidemiology; D006403:Hematologic Tests; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008727:Methotrexate / Q000009:adverse effects*; D010198:Pancytopenia / Q000139:chemically induced* / Q000401:mortality; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate