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<p>Methotrexate (MTX) is a widely prescribed disease-modifying antirheumatic drug (DMARD) used at ≤ 25&#xa0;mg/week in inflammatory conditions. Although effective, MTX-induced Pancytopenia remains a serious adverse event, often resulting from medication errors, idiosyncratic reactions, comorbidities, or polypharmacy. To comprehensively characterize methotrexate-induced Pancytopenia’s clinical profile, risk factors, and outcomes. A retrospective analysis was conducted on patients diagnosed with MTX-induced Pancytopenia between 2015 and 2024. Pancytopenia was defined as WBC &lt; 3,500/mm³, Hb &lt; 11&#xa0;g/dL, and platelets &lt; 150,000/mm³; severe pancytopenia met more stringent thresholds (WBC &lt; 2,000/mm³, Hb &lt; 10&#xa0;g/dL, platelets &lt; 50,000/mm³). Among 50 patients (35 females, median age 59.5 years), 48 had rheumatoid arthritis and 2 had psoriasis. The median MTX dose was 10&#xa0;mg/week. Common symptoms included generalized weakness (<i>n</i> = 47), fatigue (<i>n</i> = 42), fever (<i>n</i> = 37), oral ulcers (<i>n</i> = 31), bleeding (<i>n</i> = 11), and skin lesions (<i>n</i> = 10). Severe Pancytopenia occurred in 46% (<i>n</i> = 23) and was associated with significantly higher mortality (26.1% vs. 7.4%; <i>p</i> = 0.04). Medication errors were identified in 26 (52%) cases, mostly at the patient level (<i>n</i> = 23). Time-to-onset analysis revealed a bimodal distribution: early onset (1–4 weeks, median 2 weeks) in error cases, and delayed onset (6–12 months, median 8 months) in error-free patients. Severe Pancytopenia was more frequent in early-onset cases (61% vs. 29%; <i>p</i> = 0.02). Eight patients died despite intervention. MTX-induced Pancytopenia is frequently attributable to preventable errors. Early-phase vigilance, patient education, clear dosing instructions, and systemic safeguards are essential to reduce life-threatening toxicity.</p>

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Methotrexate-induced pancytopenia: clinical characteristics, medication errors, and outcomes in a tertiary care centre: a retrospective single-centre study

  • 期刊论文

  • 发表日期：

    2025年9月24日

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  • Harshwardhan Patil,
  • Shiva Prasad,
  • Ramaswamy Subramanian,
  • Mahabaleshwar Mamadapur,
  • R. Nikhil,
  • Acsah Annie Paul

摘要

Methotrexate (MTX) is a widely prescribed disease-modifying antirheumatic drug (DMARD) used at ≤ 25 mg/week in inflammatory conditions. Although effective, MTX-induced Pancytopenia remains a serious adverse event, often resulting from medication errors, idiosyncratic reactions, comorbidities, or polypharmacy. To comprehensively characterize methotrexate-induced Pancytopenia’s clinical profile, risk factors, and outcomes. A retrospective analysis was conducted on patients diagnosed with MTX-induced Pancytopenia between 2015 and 2024. Pancytopenia was defined as WBC < 3,500/mm³, Hb < 11 g/dL, and platelets < 150,000/mm³; severe pancytopenia met more stringent thresholds (WBC < 2,000/mm³, Hb < 10 g/dL, platelets < 50,000/mm³). Among 50 patients (35 females, median age 59.5 years), 48 had rheumatoid arthritis and 2 had psoriasis. The median MTX dose was 10 mg/week. Common symptoms included generalized weakness (n = 47), fatigue (n = 42), fever (n = 37), oral ulcers (n = 31), bleeding (n = 11), and skin lesions (n = 10). Severe Pancytopenia occurred in 46% (n = 23) and was associated with significantly higher mortality (26.1% vs. 7.4%; p = 0.04). Medication errors were identified in 26 (52%) cases, mostly at the patient level (n = 23). Time-to-onset analysis revealed a bimodal distribution: early onset (1–4 weeks, median 2 weeks) in error cases, and delayed onset (6–12 months, median 8 months) in error-free patients. Severe Pancytopenia was more frequent in early-onset cases (61% vs. 29%; p = 0.02). Eight patients died despite intervention. MTX-induced Pancytopenia is frequently attributable to preventable errors. Early-phase vigilance, patient education, clear dosing instructions, and systemic safeguards are essential to reduce life-threatening toxicity.