levoleucovorin and Oral-Ulcer

Methotrexate (MTX) increases the risk of alopecia and stomatitis, but the prevalence of these adverse events among rheumatic patients taking MTX is poorly defined. We conducted a systematic literature review and meta-analysis to estimate the prevalence of alopecia and stomatitis with MTX in rheumatic diseases.. We searched PubMed, The Cochrane Library, and CINAHL databases for double-blind randomized controlled trials (RCTs) with an MTX monotherapy arm. Alopecia, stomatitis, and oral/mouth ulcers data were extracted. The quality of trials was assessed by 2 authors. We included trials published since 1990 that used at least 10 mg of MTX weekly, coadministered with folic or folinic acid. We estimated the prevalence using random-effects models because heterogeneity was anticipated. Two estimates of prevalence were included; the lower bound estimate included all trials (assuming no alopecia and stomatitis if not mentioned), and the upper bound estimate included only those that specifically described prevalence estimates of alopecia or stomatitis.. Of 3,954 studies identified, 20 RCTs were included, with a total of 24 MTX monotherapy arms, of which 10 reported the prevalence of alopecia (n = 1,113), and 21 reported stomatitis or mouth/oral ulcers (n = 2,056). The prevalence of alopecia was between 1.0% and 4.9%. The prevalence of stomatitis was between 5.7% and 8.0%.. This meta-analysis gives more precise estimates of mucocutaneous adverse events that occur in rheumatic disease patients taking MTX. These estimates will help inform patient decision-making regarding MTX.

Topics: Adult; Aged; Alopecia; Antirheumatic Agents; Double-Blind Method; Female; Folic Acid; Humans; Leucovorin; Male; Methotrexate; Middle Aged; Oral Ulcer; Prevalence; Randomized Controlled Trials as Topic; Rheumatic Diseases; Stomatitis

Low-dose methotrexate (LDMTX) has been widely used for many decades in clinical settings, with good safety profiles compared with those of high-dose methotrexate. LDMTX is also used as one of the off-label conservative therapies in treating placenta accreta (PA). Until now, only a few mild adverse drug reactions (ADRs) have been published after short-term use of LDMTX, and no severe cases have been reported.. We present a case of a 30-year-old female who developed acute severe oral ulcerative mucositis with degree IV myelosuppression and degree III hepatic injury, after three doses of LDMTX to treat placenta accrete. The symptoms gradually improved after leucovorin rescue and supportive treatments.. The present case provides the first severe ADR report for the short-term use of LDMTX for treating PA, indicating that potentially life-threatening complications can also occur when using LDMTX. Early recognition and immediate leucovorin rescue could result in a favourable outcome.

Topics: Adult; Dose-Response Relationship, Drug; Female; Humans; Leucovorin; Methotrexate; Methylenetetrahydrofolate Reductase (NADPH2); Mutation; Oral Ulcer; Placenta Accreta; Pregnancy; Severity of Illness Index; Stomatitis

Topics: Aged; Antirheumatic Agents; Arthritis; Arthritis, Psoriatic; Chemical and Drug Induced Liver Injury; Cohort Studies; Drug Substitution; Female; Folic Acid; Humans; Leucovorin; Male; Methotrexate; Middle Aged; Nausea; Oral Ulcer; Retrospective Studies; Rheumatic Fever; Treatment Failure; Vitamin B Complex

The purpose of this study was to investigate the side-effects experienced by patients with colorectal cancer receiving 5-fluorouracil + folinic acid chemotherapy. A primary objective was to provide quantitative data on the incidence and severity of side-effects at each cycle of chemotherapy treatment. Twelve patients with Duke's B or Duke's C adenocarcinoma participated. Data collection was via a self-report questionnaire listing 61 possible side-effects. Participants completed a questionnaire following each cycle of chemotherapy. The response rate was 100%. Seventy-eight side-effects were reported by the sample. Fatigue was the most common side-effect (incidence = 97%) and achieved the highest C score (59/100). However, patients ranked mouth ulceration as the worst side-effect overall. Several previously unreported problems were identified, including nose bleeding, change in taste and weight loss. Although limited by a small sample size, this study suggests the problems experienced by patients undergoing 5-fluorouracil chemotherapy are many and diverse. It is concluded that investigation is needed into associations between side-effects and the role of patient characteristics in the onset of side-effects.

Topics: Adenocarcinoma; Aged; Alopecia; Antidotes; Antimetabolites, Antineoplastic; Colorectal Neoplasms; Diarrhea; Drug Therapy, Combination; Fatigue; Female; Fluorouracil; Humans; Leucovorin; Male; Middle Aged; Nausea; Oral Ulcer; Patient Satisfaction