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Pancytopenia Following Low-Dose Methotrexate Therapy

Elizabeth A. Abel, MD; Eugene M. Farber, MD
JAMA. 1988;259(24):3612. doi:10.1001/jama.1988.03720240074040.
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Drs Shupack and Webster1 have refreshed our awareness of the risk-benefit considerations for methotrexate therapy for nononcological disorders by means of their pertinent and timely description, in this issue of THE JOURNAL, of two patients who developed pancytopenia following low-dose methotrexate therapy for psoriasis. Six additional cases of methotrexate-related bone marrow suppression2 are also reviewed. Their report is particularly relevant in view of the

See also p 3594. increasing use of methotrexate therapy for rheumatoid arthritis3,4 and extra-articular manifestations of rheumatoid arthritis, including vasculitis.5 In addition, low-dose methotrexate has been investigated as a steroid-sparing agent in patients with severe asthma.6

Methotrexate is a highly effective therapy for patients with severe disabling psoriasis that is resistant to conventional topical therapy and photochemotherapy with methoxsalen and ultraviolet-A irradiation (PUVA). The drug is administered orally or intramuscularly in a weekly dosage of 7.5 to 15 mg. As a


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