Page 38 - Livre électronique des RFTP 2023

P12. MUCOCUTANEOUS TOXICITIES DUE TO
METHOTREXATE HIGH DOSE

F. CHAHED1, N. FATHALLAH, M. SASSI3, M. BARKA4, N. BEN SAYED5, N.
SASSI5, MA. KHELIFA6, R. SLIM2, B. OUNI2

1DEPARTMENT OF CLINICALPHARMACOLOGY.UNIVERSITY OF MONASTIR. FACULTY OF MEDICINE
OF MONASTIR, MONASTIR, TUNISIA; 2: METABOLICBIOPHYSICS AND
APPLIEDPHARMACOLOGYLABORATORY (LR12ES02), UNIVERSITY OF SOUSSE, SOUSSE, TUNISIA;
3FACULTY OF PHARMACY OF MONASTIR, MONASTIR, TUNISIA; 4DEPARTMENT OF SURGERY.
FARHAT HACHEDHOSPITAL, SOUSSE, TUNISIA; 5DEPARTMENT OF HEMATOLOGY. FARHAT
HACHEDHOSPITAL SOUSSE, SOUSSE, TUNISIA; 6DEPARTMENT OF ORTHOPEDICSURGERY.
SAHLOULHOSPITAL SOUSSE. TUNISIA, SOUSSE, TUNISIA

INTRODUCTION : Methotrexate (MTX) is an antifolic drug used in the treatment
of immune-mediated and neoplastic diseases. Although rare, the initiation or
dosage changes in MTX therapy can lead to mucositis or skin lesions.

OBJECTIVES : This study aimed to describe the frequency and characteristics of
the skin toxicity caused by High dose (HD) MTX.

METHODS : We retrospectively review the patients who received treatment with
systemic high-dose MTX over a period of 10 years at a National referral center for
clinical Hematology (Department of Clinical hematology of Farhat Hached
hospital-Sousse) (Tunisia). The patients who presented mucocutaneous toxicity
after MTX initiation were reviewed.

RESULTS : We identified 180 patients who received high-dose intravenous MTX
of whom 25 patients experienced skin and mucous toxicity (13.8%). Most of the
muco-cutaneous toxicity was inflammation of the mucosa (mucositis). The
mucositis are related to MTX HD administration via the IV route in all cases. The
grades of mucositis most frequently identified in our study were grades 1-2. The
median time of onset of skin disorders averaged 16 days. All patients had folinic
acid rescue during methotrexate treatment for at least 3 days.

Patients with grade 4 mucositis received folic acid for a longer duration, on average
6 days. All patients received antiseptic mouthwashes for both preventative and
therapeutic aims. 13% of these patients required the use of parenteral nutrition.
Withdrawal of MTX for mucocutaneous toxicity involved all patients with grade 3-
4 toxicity with the reintroduction of MTX therapy or its re-adminidtration after
resolution of lesions.

The clinical outcome was favorable with complete resolution of the lesions in 100%
of cases.

The study showed that the frequency of resolution decreases and the frequency
of worsening increase with the severity of the toxicity grade. The time to recovery
for this type of toxicity is mainly in the first 10 days.

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