Low-dose methotrexate in sickle-cell disease: a pilot study with rationale borrowed from rheumatoid arthritis
| Autor: | Pedro O. de Campos-Lima, José Andrés Yunes, Silvia Regina Brandalise, Rosemary Assis, Angelo Brunelli Albertoni Laranjeira |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Cancer Research medicine.medical_specialty Schmidt sting pain index Pain Gastroenterology lcsh:RC254-282 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Fever of unknown origin Adverse effect Inflammation business.industry Septic shock lcsh:RC633-647.5 Research Sickle cell disease Chronic pain Hematology lcsh:Diseases of the blood and blood-forming organs medicine.disease lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens Surgery 030104 developmental biology Methotrexate Oncology Rheumatoid arthritis Chemokines business Intramuscular injection 030215 immunology medicine.drug |
| Zdroj: | Experimental Hematology & Oncology, Vol 6, Iss 1, Pp 1-11 (2017) Experimental Hematology & Oncology |
| ISSN: | 2162-3619 |
| DOI: | 10.1186/s40164-017-0078-1 |
| Popis: | Background Inflammation is a major feature of sickle cell disease (SCD). Low-dose methotrexate (MTX) has long been used in chronic inflammatory diseases. This pilot study examined the MTX effect on acute vaso-occlusive pain crises (VOC) in SCD patients. Methods Fourteen adults on hydroxyurea with severe and refractory VOC received one intramuscular injection of 10 mg of MTX per week for 12 weeks. A single weekly dose of 5 mg of leucovorin was administered orally 48 h after each MTX injection. The primary outcome was reduction in number/intensity of acute pain episodes. The secondary outcomes were improvement of quality of life (QOL) and reduction of the inflammatory status. Results MTX did not significantly change the median VOC frequency (12 before vs 10.5 during treatment, P = 0.6240) or the median McGill pain index (45 at week 0 vs 39.5 at week 12, P = 0.9311). However, there was a decrease of ≥50% in chronic pain resulting from avascular osteonecrosis (AVN) in 5 out of 7 patients with radiologic evidence of AVN, with the perception of longer pain-free periods. There was a 44.4% median gain in physical function in the SF-36 QOL questionnaire (P = 0.0198). MTX treatment up-regulated two C-X-C motif chemokines (CXCL), CXCL10 (P = 0.0463) and CXCL12 (P |
| Databáze: | OpenAIRE |
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