Methotrexate-Induced Pancytopenia and Mucositis Caused by Medication Error

Atiase, Yacoba; Quarde, Akuffo

doi:10.4314/gmj.v54i1.9

Cited by 7 publications

(4 citation statements)

References 37 publications

(34 reference statements)

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“…The main clinical DMARDs used in present include methotrexate and leflunomide, which can reduce joint swelling and pain by reducing the acute marker cycoxoxidase (COX), so as to reduce joint damage and achieves anti-inflammatory and analgesic effects. Unfortunately, methotrexate has serious adverse reactions, such as pancytopenia, mucositis [ 20 ], interstitial lung disease [ 21 ] and even multiple organ failure due to poisoning [ 22 ]. Therefore, it is necessary to find a reliable and safe drug with good treatment effect for RA.…”

Section: Resultsmentioning

confidence: 99%

Effect and Mechanism of siRNAs Targeting IL-1β/TNF-α Combined with BMSCs Transplantation in Ameliorating Rheumatoid Arthritis in Rats

Pan

Wang

et al. 2022

Veterinary Sciences

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Background: Rheumatoid arthritis (RA) is an autoimmune disease. Bone marrow mesenchymal stem cells (BMSCs) have multilineage differentiation and anti-inflammatory potential, and small interfering RNAs (siRNAs) can inhibit the target gene expression, which make them suitable for ameliorating RA. The current study was aimed to explore the effect and potential mechanisms of siRNAs targeting IL-1β/TNF-α combined with BMSCs transplantation in ameliorating RA in rats. Methods: Collagen-induced arthritis (CIA) model rats were randomly divided into five groups: PBS (Model control group), methotrexate (Positive drug treatment group), BMSCs (BMSCs transplantation group), siRNA (IL-1β/TNF-α siRNAs injection group), siRNA + BMSCs (Both IL-1β/TNF-α siRNAs injection and BMSCs transplantation group). After treatment for 0, 7, 14, 21, 28 days, the ameliorating effect was comprehensively assessed through results of the body weight, toe swelling value, the immobility time of forced swimming, the serum concentrations of IL-1β and TNF-α, knee joint DR-X imaging and pathological analysis as well as of IL-1β, TNF-α and NF-κB mRNA expression in spleen tissue. Furthermore, the potential underlying mechanism involving the NF-κB signaling pathways was also explored. Results: Compared with the PBS group, BMSCs, siRNA, siRNA + BMSCs treatment groups showed significant lower toe swelling value, immobility time, spleen index, serum contents of IL-1β and TNF-α. In addition, the DR-X results showed that the knee carton surface tended to smoothing without bone hyperplasia, suggesting that these three treatments were all able to successfully ameliorate RA symptoms. In addition, compared with the PBS group, the protein expression of p-NF-κB-p65 was significantly reduced in the knees of siRNA + BMSCs rats. BMSCs labeled with BrdU were also found in the knees of rats. Moreover, the mRNA expression of IL-1β, TNF-α and NF-κB-P65 in spleen tissue of siRNA + BMSCs rats were all significantly inhibited. Conclusions: Our results demonstrated for the first time that siRNA + BMSCs was able to ameliorate RA inflammation by inhibiting the activation of NF-κB signaling pathways and reducing the erosion of articular cartilage, and siRNA + BMSCs treatment showed synergism effects in helping ameliorating the inflammation and cartilage repair of RA rats. Therefore, the results of our present study provide a new idea for gene and stem cell therapy for RA.

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Section: Resultsmentioning

confidence: 99%

Effect and Mechanism of siRNAs Targeting IL-1β/TNF-α Combined with BMSCs Transplantation in Ameliorating Rheumatoid Arthritis in Rats

Pan

Wang

et al. 2022

Veterinary Sciences

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“…To prevent medical errors, it is important for the clinician when initiating methotrexate to provide an elaborate and clear prescription to the patient mention the number of tablets to be consumed, also using the same strength of the tablets, the timing of administration, and fix a day for methotrexate and a day for folic acid administration. It is usually remembered as M for Methotrexate and M for Monday, F for Folic acid and F for Friday [9]. It is also imperative for the pharmacist to properly read the prescription and discuss it with the clinician if required to ensure proper dosing, possible interactions, and review of adverse events.…”

Section: Discussionmentioning

confidence: 99%

A Fatal Fate: A Medical Error Leading to Acute Methotrexate Toxicity

Khan¹,

Batool²,

Naveed³

et al. 2022

Cureus

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Methotrexate is an anti-metabolite, which is commonly utilized as an anti-cancer, anti-rheumatic, and antiinflammatory drug used to treat a large variety of connective tissue disorders. Methotrexate when consumed at low doses for longer periods usually has a very limited side effect profile, however, accidental ingestion of large methotrexate doses is common which can result in a wide variety of adverse effects and can even result in fatal demise.We, unfortunately, relate the incidence of a 75-year-old female, who unintentionally consumed 200mg of methotrexate instead of methylcobalamin because the pharmacist misunderstood the prescription. The patient presented to the Accident and Emergency (A&E) department of Jinnah Hospital, Karachi, with extensive hemorrhagic oral ulcers, maculopapular dermatitis, and inability to swallow, which further progressed to acute renal insufficiency, neutropenic sepsis, and respiratory distress. The patient was managed with leucovorin rescue therapy, intravenous rehydration, urinary alkalinization, neutropenic protocol, and oxygen support given her respiratory distress, and hemodialysis was arranged for her renal insufficiency. However, despite all these measures the patient met an unfortunate fate and expired.Patients should be given accurate dosage directions, detailed textural information, and audio-visual resources. Additionally, symptoms of toxicity should be explained to all patients. Measures should be taken to minimize such unfortunate events in the future.

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“…Thus, mucositis develops when a patient's oral epithelial cells are affected. Myelosuppression in patients with methotrexate toxicity is explained by the same mechanism [14]. As a result, pancytopenia develops, which leads to increased bleeding, easy bruising, macrocytic red blood cells, and an increased risk of infections [15].…”

Section: Discussionmentioning

confidence: 99%

Methotrexate-Induced Septicemia With Severe Pancytopenia and Diffuse Cutaneous Ulcerative Lesions

Tiewsoh¹,

Dey²,

Chhangte³

et al. 2021

Cureus

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Methotrexate, a folate antimetabolite and one of the first few anti-neoplastic drugs, is now a commonly used drug in the treatment of many inflammatory disorders ranging from diseases like rheumatoid arthritis to psoriasis. The life-threatening toxicity of methotrexate in inflammatory diseases is not commonly encountered. Here we report a case of life-threatening multiorgan failure from methotrexate toxicity, which was given for skin lesions suspected to be psoriasis.

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Methotrexate-Induced Pancytopenia and Mucositis Caused by Medication Error

Cited by 7 publications

References 37 publications

Effect and Mechanism of siRNAs Targeting IL-1β/TNF-α Combined with BMSCs Transplantation in Ameliorating Rheumatoid Arthritis in Rats

Effect and Mechanism of siRNAs Targeting IL-1β/TNF-α Combined with BMSCs Transplantation in Ameliorating Rheumatoid Arthritis in Rats

A Fatal Fate: A Medical Error Leading to Acute Methotrexate Toxicity

Methotrexate-Induced Septicemia With Severe Pancytopenia and Diffuse Cutaneous Ulcerative Lesions

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