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Case Reports
. 2001 Dec;35(12):1575-7.
doi: 10.1345/aph.1A052.

Severe pancytopenia associated with low-dose methotrexate therapy for rheumatoid arthritis

J M Calvo-Romero  1
Affiliations
Case Reports

Severe pancytopenia associated with low-dose methotrexate therapy for rheumatoid arthritis

J M Calvo-Romero. Ann Pharmacother. 2001 Dec.

Abstract

Objective: To report the occurrence of severe pancytopenia associated with low-dose methotrexate (MTX) therapy for rheumatoid arthritis.

Case summary: Two patients developed severe pancytopenia after 10 days (cumulative dose 15 mg) and 23 months (cumulative dose 1030 mg), respectively, of low-dose MTX therapy for rheumatoid arthritis. Both patients had renal impairment. One died and the other recovered completely.

Discussion: Pancytopenia is a rare adverse effect of low-dose oral MTX therapy. The exact mechanism for development of pancytopenia is unknown, although it is likely that several factors play a role. The most important risk factor for MTX toxicity is impaired renal function. This adverse effect may occur at any time during MTX therapy.

Conclusions: Severe pancytopenia associated with low-dose MTX therapy for rheumatoid arthritis is a potentially serious complication that may occur at any time during therapy. This adverse effect is more likely to occur in patients with renal impairment.

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