Methotrexate-related pancytopenia-factors that contribute to its development and outcomes

Abstract

Methotrexate, a commonly used disease-modifying anti-rheumatoid drug, rarely causes bone marrow suppression and pancytopenia. Consequently, we made a retrospective analysis of all patients who were admitted with pancytopenia following low-dose methotrexate intake between 2019 and 2025. Factors that were associated with the development of toxicity, clinical features and outcomes were evaluated. Among those who developed early toxicity, the majority had inadvertently taken daily instead of weekly doses. Renal failure, elderly age and hypoalbuminaemia contributed to delayed toxicity. All were given Folinic acid rescue therapy and 20% needed transfusion support. Two succumbed due to severe neutropenia-related sepsis. Simple patient education on once a week use, dose adjustment and frequent monitoring in the elderly and those with renal failure may help to reduce toxicity.