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Effect of allopurinol versus urate oxidase on methotrexate pharmacokinetics in children with newly diagnosed acute lymphoblastic leukemia
Cancer, 10/26/09

Crews KR et al. – The lower rate of methotrexate clearance in patients who received allopurinol likely reflected a less potent hypouricemic effect of allopurinol, leading to precipitation of uric acid in renal tubules. Hence, during remission induction therapy for lymphoid malignancies, it was concluded that renally excreted drugs should be monitored closely, especially in patients who are receiving allopurinol.

Methods

Plasma methotrexate pharmacokinetics in pediatric patients with newly diagnosed acute lymphoblastic leukemia who received concomitant allopurinol (n = 20) versus those treated with nonrecombinant or recombinant urate oxidase (n = 96) during high-dose methotrexate administration before conventional remission induction therapy compared

Results

Minimum plasma concentration of uric acid significantly lower after urate oxidase treatment than concentration after allopurinol treatment
Methotrexate clearance significantly higher in patients who received urate oxidase
Higher proportion of patients in allopurinol group had elevated methotrexate plasma concentrations and experienced mucositis after methotrexate treatment compared with urate oxidase group