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Methotrexate assay update: an assessment from Southampton General Hospital

Methotrexate, a toxic chemotherapeutic agent used to treat various conditions, requires close laboratory monitoring. Here, Rick Allan and Kevin Sensier describe their evaluation of two assays.

A commonly used therapeutic agent for the treatment of tumours of the head, neck, lung, skin and breast, methotrexate (MTX) is given in high doses and can be extremely toxic. Patients must be closely monitored, and concentrations need to be checked 24, 48 and 72 hours after the drug is administered. 

A 24/7 methotrexate analysis service is therefore essential to provide accurate, quantitative and sensitive determination that enables clinicians to manage their patients’ treatment correctly. After initial dosage, MTX concentration is around 10 µmol/L, which should then fall to below 0.05 µmol/L. This is key, as the patient is also given folinic acid (leucovorin) in order to ‘rescue’ them from the awful side effects of MTX. Guidelines recommend continuance of leucovorin until the MTX level falls below 0.05 µmol/L.

Method comparison
In order to assess the MTX analysis service offered in Southampton, Rick Allan and Kevin Sensier recently perfomed an evaluation of two MTX methods. Here, they report their findings.

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