Glucarpidase Improves Outcomes in Patients With Methotrexate-Induced Kidney Toxicity

THURSDAY, Jan. 16, 2025 (HealthDay News) — For patients with methotrexate (MTX)-acute kidney injury (AKI), glucarpidase is associated with improved renal and extrarenal outcomes, according to a study published online Jan. 6 in Blood.

Shruti Gupta, M.D., M.P.H., from Brigham and Women”s Hospital in Boston, and colleagues examined the association between glucarpidase administration and outcomes among adults with MTX-AKI from 28 cancer centers across the United States. Outcomes were compared for patients who received glucarpidase within four days following MTX initiation and those who did not; data were included for 708 patients with MTX-AKI, 209 (29.5 percent) of whom received glucarpidase.

The researchers found that 25.8 percent of patients had a primary end point event (kidney recovery at hospital discharge). Compared with no glucarpidase receipt, receipt was associated with 2.70-fold increased odds of kidney recovery. In addition, patients receiving glucarpidase had faster time to kidney recovery (adjusted hazard ratio, 1.88) and lower risks for grade ≥2 neutropenia and grade ≥2 transaminitis on day 7 (adjusted odds ratios, 0.50 and 0.50, respectively). No difference was seen between the groups in time to death.

“We found that patients with MTX-AKI treated with glucarpidase had a higher adjusted odds of kidney recovery compared to those not treated with glucarpidase,” the authors write. “Randomized clinical trials are needed to confirm our findings, and also to explore the efficacy of glucarpidase in patients with plasma MTX levels that do not meet thresholds suggested by current guidelines.”

Several authors disclosed ties to biopharmaceutical and health care companies, including BTG International, which funded the study.

Abstract/Full Text (subscription or payment may be required)