Leprosy Mailing List – November 10, 2017
Ref.: (LML) Steroid Dependency and the use of Methotrexate
From: Ben Naafs, Munnekeburen, the Netherlands
Dear Pieter,
I would like to refer to the LML letter from Arry Pongtiku, Papua, Indonesia, of 9-11-2017. I am glad he wants to start a study. Studies teach a lot and help you determine if you've got a viable idea.
Laboratory test to be performed (attached file image001) from A Family Physician's Guide to Monitoring Methotrexate Am Fam Physician. 2000.
- It is important to monitor the liver functions, MTX can liver cirrhosis. Be careful with alcoholics for that reason.
- Bone depression may occur: so, check hematologic values regularly.
- TB is a problem with MTX so be sure that is treated. (TB also may be a trigger for ENL)
- More to be aware off: MTX can give pneumonitis and some lung fibrosis.
- Kidney function should also be monitored as it influences availability. MTX is contraindicated in any patient with a creatinine clearance of less than 50 mL per minute. Check before treatment and twice a year while on treatment.
This is an old adagio: do not go above 1,5 g total because the risk of adverse effect increases.
Both women and men of reproductive age should use birth control during methotrexate therapy. There have been however few foetal abnormalities definitive declared to MTX
Liver biopsies are to date hardly necessary anymore and gave death in the past.
Some people do not absorb MTX from the gastroenteric tract, the people may require injections.
I hope this overview and the suggestions are useful.
Ben Naafs
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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