Faculty Collaboration Database

Implementation and evaluation of high-dose methotrexate administration guidelines. J Oncol Pharm Pract 2019 Oct;25(7):1675-1681

Date

10/27/2018

Pubmed ID

30360674

DOI

10.1177/1078155218808866

Scopus ID

2-s2.0-85059348123 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: High-dose methotrexate is used to treat a variety of malignancies. Methotrexate-associated supportive care and the threshold methotrexate level for the discontinuation of supportive care are not consistent among studies. We evaluated the implementation of high-dose methotrexate administration guidelines, which raised the standard threshold methotrexate level for the discontinuation of supportive care from <0.05 to <0.1 µmol.

METHODS: A single-center, observational analysis of patients receiving high-dose methotrexate from 1 January 2015 to 31 May 2017 was conducted. The primary endpoint was time from the start of the methotrexate infusion until the discontinuation of the sodium bicarbonate infusion, before and after guideline implementation.

RESULTS: Fifty-two patients met the inclusion criteria, which comprised of a total of 136 individual methotrexate doses and were included in the retrospective analysis. Twenty-four patients were included in the prospective analysis, which comprised a total of 46 individual methotrexate doses. The primary endpoint, time until discontinuation of the sodium bicarbonate infusion, was a median of 97.7 h in the retrospective group versus 73.2 h in the prospective group (p = 0.098). Secondary endpoints also favored patients in the prospective group, including hours of hospitalization, number of methotrexate levels checked, weight gained during admission, and adherence to the guideline.

CONCLUSION: Among patients who received high-dose methotrexate, implementation of a guideline using a methotrexate threshold of <0.1 µmol was able to significantly decrease the time to discontinuation of supportive care and subsequently may lead to early hospital discharge given that we did not show a statistical significance.

Author List

Nowak TJ, Lorge AH, Rein LE, Canadeo AM, Frank JP, Samanas LC, Urmanski AM, Atallah EL

Authors

Ehab L. Atallah MD Professor in the Medicine department at Medical College of Wisconsin
Lisa E. Rein Biostatistician III in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Antimetabolites, Antineoplastic
Female
Humans
Infusions, Intravenous
Male
Methotrexate
Middle Aged
Neoplasms
Palliative Care
Patient Discharge
Practice Guidelines as Topic
Prospective Studies
Retrospective Studies
Sodium Bicarbonate
Young Adult