Acute versus chronic methotrexate poisoning; a cross-sectional study

Area of Science:

• Toxicology
• Pharmacology
• Oncology

Background:

• Limited data exists comparing acute versus chronic methotrexate (MTX) poisoning.
• Methotrexate is an anti-folate drug used for malignant and inflammatory conditions.
• Understanding toxicity differences is crucial for patient management.

Purpose of the Study:

• To compare the signs, symptoms, complications, treatment, and outcomes of acute and chronic MTX toxicity.
• To identify key differences in clinical presentation and management between acute and chronic MTX poisoning.

Main Methods:

• Retrospective study of patients with MTX poisoning hospitalized between March 2010 and March 2018.
• Patients were divided into acute (MTX use < 7 days) and chronic (MTX use > 7 days) toxicity groups.
• Comparison of clinical data, laboratory findings, and treatment received.

Main Results:

• 13 acute and 14 chronic MTX poisoning cases were analyzed.
• Chronic MTX toxicity showed significantly higher rates of mucosal ulcers, skin lesions, leukopenia, thrombocytopenia, anemia, elevated BUN, and creatinine.
• Mean age was significantly higher in the chronic toxicity group.

Conclusions:

• Chronic MTX poisoning is more severe than acute toxicity.
• Higher incidence of dermatologic, hematologic, and hepatic complications in chronic cases.
• Chronic toxicity may require more aggressive treatments, including higher leucovorin doses or G-CSF, potentially due to patient factors like older age.