慢性関節リウマチ患者におけるメトトレキセートによる骨髄障害　　国内外の報告の総覧

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書誌事項

タイトル別名
  • Methotrexate-induced Bone Marrow Failure in Patients with Rheumatoid Arthritis: Review of Both Overseas and Domestic Reports.
  • マンセイ カンセツ リウマチ カンジャ ニ オケル メトトレキセート ニ ヨル コツズイ ショウガイ : コクナイガイ ノ ホウコク ノ ソウラン
  • REVIEW OF BOTH OVERSEAS AND DOMESTIC REPORTS
  • ―国内外の報告の総覧―

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抄録

The fatal pancytopenia associated with methotrexate (MTX) treatment in patients with rheumatoid arthritis is reviewed in both the English as well as in the Japanese literature. MTX has been used as one of the disease-modifying antirheumatic drugs (DMARD) in Japan since March 1999, Due to the fact that MTX is known to have a strong inhibitory effect on the folate metabolism and DNA synthesis, special attention should be paid to myelosuppression.<br>However, the rate of myelosuppression has been reported to be around 10% while that of pancytopenia is as low as 1-2% followed by a non-fatal outcome. We consider that both the rate of pancytopenia as well as death has not yet been sufficiently evaluated. We therefore searched for any reports on the side effects of MTX on MEDLINE CD-ROM and Japana Centra Revuo Medicina CD-ROM, which included all reports up untill the end of 2000. As a result, we found 99 cases in the English literature and 37 cases in the Japanese literature with reported death rates of 25% and 13%, respectively. Based on these findings, the most important factor for the occurrence of bone marrow supression is considered to be renal impairment. In addition, trimethoprim-sulf amethoxazole and salazosulf apyridine, both of which are f olate metabolism blockers, were found to be cofactors for severe suppression. However, no specific causes have yet been indicated in the majority of the patients. In serious cases, bleeding and infection were followed by multiple organ failure as well as DIC. Surprisingly enough, as few as two administrations of MTX have been reported to cause fatal pancytopenia. Doctors should therefore pay more attention to any sudden onset of severe bonemarrow suppression right after the administration of MTX and also always be ready to administer such folate derivatives as Leucovorin as well as G-CSF to promote bonemarrow recovery when necessary. Furthermore, sufficient information on the action and side effects of MTX and the dosage schedules should also be provided to all patients receiving MTX.

収録刊行物

  • 医療

    医療 55 (7), 311-321, 2001

    一般社団法人 国立医療学会

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