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...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-10-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1237178/full |
| _version_ | 1797650825398452224 |
|---|---|
| author | Aditya Sharma Philip Benoit Frederick Lansigan David Nierenberg |
| author_facet | Aditya Sharma Philip Benoit Frederick Lansigan David Nierenberg |
| author_sort | Aditya Sharma |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-11T16:07:12Z |
| format | Article |
| id | doaj.art-5ea5472c19904c50bb4b3c7f0a19acdf |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-11T16:07:12Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-5ea5472c19904c50bb4b3c7f0a19acdf2023-10-24T23:59:32ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-10-011310.3389/fonc.2023.12371781237178Case Report: Serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidoteAditya Sharma0Philip Benoit1Frederick Lansigan2David Nierenberg3Department of Medicine, Dartmouth Health, Lebanon, NH, United StatesDivision of Hematology/Oncology, Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, United StatesDivision of Hematology/Oncology, Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, United StatesDepartment of Pharmacology, Dartmouth Health, Lebanon, NH, United StatesMethotrexate 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.https://www.frontiersin.org/articles/10.3389/fonc.2023.1237178/fullmethotrexateserummonitoringantidoteglucarpidaseleucovorin |
| spellingShingle | Aditya Sharma Philip Benoit Frederick Lansigan David Nierenberg Case Report: Serum methotrexate monitoring by immunoassay: confusion by by-product, confusion by antidote Frontiers in Oncology methotrexate serum monitoring antidote glucarpidase leucovorin |
| 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 | methotrexate serum monitoring antidote glucarpidase leucovorin |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1237178/full |
| work_keys_str_mv | AT adityasharma casereportserummethotrexatemonitoringbyimmunoassayconfusionbybyproductconfusionbyantidote AT philipbenoit casereportserummethotrexatemonitoringbyimmunoassayconfusionbybyproductconfusionbyantidote AT fredericklansigan casereportserummethotrexatemonitoringbyimmunoassayconfusionbybyproductconfusionbyantidote AT davidnierenberg casereportserummethotrexatemonitoringbyimmunoassayconfusionbybyproductconfusionbyantidote |