Methotrexate
Özet
Methotrexate is an immunosuppressive drug used successfully in many dermatological indications. Patients in the geriatric population, may be more sensitive to significant side effects of methotrexate, such as hepatotoxicity, pancytopenia, renal and pulmonary toxicity, due to age-related decreases in albumin concentration and renal and liver functions. In addition to age-related physiological changes, risks such as comorbidities, multiple drug use, and drug misuse due to decreased cognitive functions require careful use of methotrexate. Routine monitoring of laboratory parameters and folic acid supplementation are recommended to ensure the safety and tolerability of methotrexate use in elderly patients.
Referanslar
Gubner RS. Introduction of antifolics in psoriasis. A twenty-five year retrospect of antineoplastic agents in nonmalignant disease. Cutis 1979; 23: 425–8.
Shen S, O'Brien T, Yap LM, Prince HM, McCormack CJ. The use of methotrexate in dermatology: a review. Australas J Dermatol. 2012;53(1):1-18.
Shah RA, Nwannunu CE, Limmer AL, Patel RR, Mui UN, Tyring SK. Brief Update on Dermatologic Uses of Methotrexate. Skin Therapy Lett. 2019;24(6):5-8.
Mocanu M, Procopciuc D, Gheucă-Solovăstru DF, et al. An Overview of Methotrexate Indications in Skin Diseases. Medicina (Kaunas). 2024;60(7):1024. .
Bangert CA, Costner MI. Methotrexate in dermatology. Dermatol Ther. 2007;20(4):216-28. .
Montesinos MC, Desai A, Cronstein BN. Suppression of inflammation by low-dose methotrexate is mediated by adenosine A2A receptor but not A3 receptor activation in thioglycollate-induced peritonitis. Arthritis Res Ther. 2006;8(2):R53.
Cronstein B. How does methotrexate suppress inflammation? Clin Exp Rheumatol. 2010;28(5 Suppl 61):S21-3.
Warren RB, Weatherhead SC, Smith CH, et al. British Association of Dermatologists' guidelines for the safe and effective prescribing of methotrexate for skin disease 2016. Br J Dermatol. 2016;175(1):23-44.
Fougerousse AC, Mery-Bossard L, Parier J, Taieb C, Bertolotti A, Maccari F; GEM ResoPso. Use of Methotrexate in the Treatment of Moderate to Severe Plaque Psoriasis in France: A Practice Survey. Clin Cosmet Investig Dermatol. 2021;14:389-393.
Morgacheva O, Furst DE. Use of MTX in the elderly and in patients with compromised renal function. Clin Exp Rheumatol. 2010;28(5 Suppl 61):S85-94.
Bedoui Y, Guillot X, Sélambarom J, et al. Methotrexate an Old Drug with New Tricks. Int J Mol Sci. 2019;20(20):5023.
Fairris GM, Dewhurst AG, White JE, Campbell MJ. Methotrexate dosage in patients aged over 50 with psoriasis. BMJ. 1989;298(6676):801-2. .
Xia, F., Cremer, J. & Butler, D.C. Dermatology Medications in Older Adults: Common Medications and Considerations. Curr Geri Rep2026; 5: 259–265.
Ali GF, Hassanein EHM, Mohamed WR. Molecular mechanisms underlying methotrexate-induced intestinal injury and protective strategies. Naunyn Schmiedebergs Arch Pharmacol. 2024. .
Kivity S, Zafrir Y, Loebstein R, Pauzner R, Mouallem M, Mayan H. Clinical characteristics and risk factors for low dose methotrexate toxicity: a cohort of 28 patients. Autoimmun Rev. 2014;13(11):1109-13.
Kameda H, Yamaoka K, Yamanishi Y, et al. Japan College of Rheumatology guidance for the use of methotrexate in patients with rheumatoid arthritis: Secondary publication. Mod Rheumatol. 2023;34(1):1-10. .
Dong J, Bonomo L, Lebwohl M. Common Adverse Drug-Drug Interactions in Dermatology: Oral Therapies. J of Skin. 2017;1(2):74-82.
Bourré-Tessier J, Haraoui B. Methotrexate drug interactions in the treatment of rheumatoid arthritis: a systematic review. J Rheumatol. 2010;37(7):1416-21.
Hanoodi M, Mittal M. Methotrexate. 2023 Aug. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32310574.
Kumar C, Kuhn M, Herrmann K, Leuchten N, Aringer M. Severe methotrexate toxicity in elderly patients under diuretics. RMD Open. 2024;10(1):e003827.
The effect of age and renal function on the efficacy and toxicity of methotrexate in rheumatoid arthritis. Rheumatoid Arthritis Clinical Trial Archive Group. J Rheumatol. 1995;22(2):218-23. .
Romão VC, Lima A, Bernardes M, Canhão H, Fonseca JE. Three decades of low-dose methotrexate in rheumatoid arthritis: can we predict toxicity? Immunol Res. 2014;60(2-3):289-310.
Wolfe F, Cathey MA. The effect of age on methotrexate efficacy and toxicity. J Rheumatol. 1991;18(7):973-7.
Bisht K, Mohan B, Jatteppanavar B, Sony HT, Handu S, Dhar M. An observational study of root-cause analysis of medication errors in elderly with methotrexate toxicity. Expert Opin Drug Saf. 2024;23(5):593-597.
Lim AY, Gaffney K, Scott DG. Methotrexate-induced pancytopenia: serious and under-reported? Our experience of 25 cases in 5 years. Rheumatology (Oxford). 2005;44(8):1051-5.
Hirshberg B, Muszkat M, Schlesinger O, Rubinow A. Safety of low dose methotrexate in elderly patients with rheumatoid arthritis. Postgrad Med J. 2000;76(902):787-9.
Gutierrez-Ureña S, Molina JF, García CO, Cuéllar ML, Espinoza LR. Pancytopenia secondary to methotrexate therapy in rheumatoid arthritis. Arthritis Rheum. 1996;39(2):272-6. .
Arumahandi de Silva AN, Frommert LM, Albach FN, et al. Pausing methotrexate improves immunogenicity of COVID-19 vaccination in elderly patients with rheumatic diseases. Ann Rheum Dis. 2022;81(6):881-888.
