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Central nervous system toxicity associated with weekly low-dose methotrexate treatment
Arthritis and Rheumatism
|June 1, 1989
Summary
Central nervous system (CNS) toxicity from low-dose methotrexate (MTX) is more common than previously thought. Older patients with mild kidney impairment are particularly susceptible to these MTX-related CNS effects.
Area of Science:
- Neurology
- Pharmacology
Background:
- Central nervous system (CNS) toxicity from low-dose methotrexate (MTX) is considered rare.
- Reported symptoms primarily include dizziness and headache.
Purpose of the Study:
- To investigate the incidence and characteristics of CNS toxicity in patients receiving low-dose MTX.
- To identify patient factors associated with MTX-induced CNS toxicity.
Main Methods:
- Retrospective review of 25 consecutive patients treated with low-dose MTX.
- Analysis of spontaneously reported CNS symptoms, including cranial sensations, mood alteration, and memory impairment.
- MTX rechallenge in a subset of patients to confirm causality.
Main Results:
- Five out of 25 patients reported CNS symptoms.
- Recurrent CNS symptoms were observed in all 3 patients who underwent MTX rechallenge.
- Patients experiencing CNS toxicity were older (mean age 68 vs. 50) and had higher baseline serum creatinine levels (1.3 vs. 0.9 mg/dl) compared to those without toxicity.
- Weekly MTX dosage was similar between groups.
Conclusions:
- CNS toxicity associated with low-dose MTX may be more frequent than previously recognized.
- Older age and mild renal insufficiency are risk factors for MTX-induced CNS toxicity.
- CNS toxicity can be a significant reason for MTX discontinuation.