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Article
November 25, 1988

Methotrexate Therapy for Psoriasis-Reply

Author Affiliations

Stanford (Calif) University School of Medicine
Psoriasis Research Institute Palo Alto, Calif

Stanford (Calif) University School of Medicine
Psoriasis Research Institute Palo Alto, Calif

JAMA. 1988;260(20):3005. doi:10.1001/jama.1988.03410200047016
Abstract

In Reply.—  Drs Shupack and Webster1 have made a contribution by calling to our attention that the use of methotrexate for psoriasis is a two-edged sword. We know the benefits of this treatment, but it is important to bear in mind its risks. The two additional case reports of methotrexate-associated pancytopenia underscore the concern for proper assessment of renal function along with periodic hematologic and hepatic evaluations of patients receiving long-term methotrexate therapy. These reports support Drs Shupack and Webster's admonition for avoidance of the drug in patients with renal insufficiency or hematologic instability and for discontinuation of methotrexate use when concomitant drug therapy may affect renal function by drug interaction.In the patient reported by Drs Grigg and Hare, her fatal pancytopenia was considered multifactorial in nature. Increased drug levels of methotrexate resulted partly from impaired excretion due to altered fluid intake and dehydration, in addition to displacement

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