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Case Report: Serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidote

Methotrexate is a commonly used agent in the treatment of many malignancies and rheumatologic/inflammatory diseases. Working by inhibiting dihydrofolate reductase and thereby preventing eventual formation of tetrahydrofolate, methotrexate inhibits synthesis of purines and thymidylate, therefore disa...

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Autores principales: Sharma, Aditya, Benoit, Philip, Lansigan, Frederick, Nierenberg, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10628483/
https://www.ncbi.nlm.nih.gov/pubmed/37941559
http://dx.doi.org/10.3389/fonc.2023.1237178
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author Sharma, Aditya
Benoit, Philip
Lansigan, Frederick
Nierenberg, David
author_facet Sharma, Aditya
Benoit, Philip
Lansigan, Frederick
Nierenberg, David
author_sort Sharma, Aditya
collection PubMed
description Methotrexate is a commonly used agent in the treatment of many malignancies and rheumatologic/inflammatory diseases. Working by inhibiting dihydrofolate reductase and thereby preventing eventual formation of tetrahydrofolate, methotrexate inhibits synthesis of purines and thymidylate, therefore disabling a malignant cell’s ability to replicate. While it is able to effectively do this, methotrexate also holds potential for significant toxicity. Therefore, serum methotrexate monitoring is of utmost importance when administering the drug, particularly when high doses are used. Although there are several different measurement systems, the immunoassay is a commonly used monitoring system that may be prone to interference when using agents with similar carbon backbone as methotrexate, including folinic acid (leucovorin) at high doses, as well as in the setting of glucarpidase use and consequent methotrexate breakdown. However, adjusting leucovorin dosing policy and being aware of the potential of the immunoassay to be “confused” by similar molecules have allowed for the efficient and effective use of the immunoassay while preventing prolonged hospital stays at our institution.
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spelling pubmed-106284832023-11-08 Case Report: Serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidote Sharma, Aditya Benoit, Philip Lansigan, Frederick Nierenberg, David Front Oncol Oncology Methotrexate is a commonly used agent in the treatment of many malignancies and rheumatologic/inflammatory diseases. Working by inhibiting dihydrofolate reductase and thereby preventing eventual formation of tetrahydrofolate, methotrexate inhibits synthesis of purines and thymidylate, therefore disabling a malignant cell’s ability to replicate. While it is able to effectively do this, methotrexate also holds potential for significant toxicity. Therefore, serum methotrexate monitoring is of utmost importance when administering the drug, particularly when high doses are used. Although there are several different measurement systems, the immunoassay is a commonly used monitoring system that may be prone to interference when using agents with similar carbon backbone as methotrexate, including folinic acid (leucovorin) at high doses, as well as in the setting of glucarpidase use and consequent methotrexate breakdown. However, adjusting leucovorin dosing policy and being aware of the potential of the immunoassay to be “confused” by similar molecules have allowed for the efficient and effective use of the immunoassay while preventing prolonged hospital stays at our institution. Frontiers Media S.A. 2023-10-24 /pmc/articles/PMC10628483/ /pubmed/37941559 http://dx.doi.org/10.3389/fonc.2023.1237178 Text en Copyright © 2023 Sharma, Benoit, Lansigan and Nierenberg https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Sharma, Aditya
Benoit, Philip
Lansigan, Frederick
Nierenberg, David
Case Report: Serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidote
title Case Report: Serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidote
title_full Case Report: Serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidote
title_fullStr Case Report: Serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidote
title_full_unstemmed Case Report: Serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidote
title_short Case Report: Serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidote
title_sort case report: serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidote
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10628483/
https://www.ncbi.nlm.nih.gov/pubmed/37941559
http://dx.doi.org/10.3389/fonc.2023.1237178
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