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Low Serum Albumin Level Is a Risk Factor for Delayed Methotrexate Elimination in High-Dose Methotrexate Treatment

Tatsuo Kataoka1,2, Hiroshi Sakurashita1, Kazuya Kajikawa1

  • 1Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, Japan.

The Annals of Pharmacotherapy
|February 5, 2021
PubMed
Abstract

Insights

Low serum albumin (ALB) levels are a key risk factor for delayed high-dose methotrexate (HD-MTX) elimination. This finding is crucial for managing HD-MTX therapy and preventing adverse events in cancer patients.

Area of Science:

  • Oncology
  • Pharmacology
  • Clinical Medicine

Background:

  • Delayed elimination of high-dose methotrexate (HD-MTX) can cause severe adverse effects.
  • Risk factors for delayed plasma methotrexate elimination remain unclear.

Purpose of the Study:

  • To investigate factors associated with delayed MTX elimination in patients undergoing HD-MTX monotherapy.

Main Methods:

  • Retrospective study of 74 patients receiving HD-MTX monotherapy.
  • Patients categorized into
  • Normal
  • and
  • Delayed
  • groups based on plasma MTX levels at 48/72 hours.
  • Analysis of patient characteristics, MTX dose, plasma concentration, and adverse effects.

Main Results:

  • Low serum albumin (ALB) level (<3.7 g/dL) identified as a significant risk factor.
  • Type of cancer also associated with delayed MTX elimination (multivariate analysis: AOR=8.11, P=0.018).
  • No significant difference in adverse effects between groups, except for renal impairment.

Conclusions:

  • Low ALB is a critical risk factor for delayed MTX elimination in HD-MTX monotherapy.
  • Further pharmacokinetic studies are needed to guide HD-MTX dosing in patients with low ALB levels.
Keywords:
adverse drug reactionsmedication therapy managementmethotrexateoncologytherapeutic monitoring

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