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MTX Monitoring Tool
Guidelines
Educational and Downloadable Tools
Expert Discussions
Clinical Articles

Methotrexate (MTX) Monitoring Tool

MTXPK.org

MTXPK.org is a powerful tool that helps you monitor how well your patients are clearing MTX. MTXPK.org can be used to determine when Voraxaze® (glucarpidase) is indicated for your patients and you can get started with a single MTX and serum creatinine (SCr) lab value1,2:

  • Know when to expect your patient’s MTX concentration to reach a level acceptable for discharge
  • Evaluate your patient’s expected MTX clearance
  • Compare your patient’s MTX clearance with the population mean and 2 SD above the mean
  • See how your patient’s MTX levels compare with levels known to confer risk for serious MTX toxicity based on expert consensus guidelines
  • Evaluate SCr trend
  • Anticipate and diagnose delayed MTX clearance early, allowing you to act within the critical treatment window of 48-60 hours to lower circulating MTX levels and facilitate renal recovery1,3,4

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MTXPK Tutorial Video

A brief tutorial that walks you step by step through the process of using MTXPK.org to monitor your patients’ methotrexate (MTX) clearance.

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MTXPK.org - Background, Overview and Applications

In partnership with the HOPA Industry Relations Council, please check out this recorded “Ask the Experts” interactive discussion on MTXPK.org!  

In this recorded session, you will hear from Laura Ramsey, PhD, the creator of MTXPK.org and primary author of the Consensus Guidelines, as well as Jill Lykon, PharmD, BCOP, a clinical hematology/oncology pharmacy coordinator from the University of Miami Hospital and Clinics who reviews practical applications of MTXPK.org

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MTXPK.org Clinical Applications Leave-Behind

This quick resource provides you with an overview of MTXPK.org, including key features and benefits of using MTXPK.org to monitor how well your patients are clearing methotrexate (MTX).
 

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MTXPK.org: A Clinical Decision Support Tool Evaluating High‐Dose Methotrexate Pharmacokinetics to Inform Post‐Infusion Care and Use of Glucarpidase

Overview of the web-based clinical decision support tool, MTXPK.org, that helps clinicians monitor whether patients are clearing methotrexate (MTX) as expected.

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Guidelines

Consensus Guidelines for Voraxaze® (glucarpidase) Use

Consensus Guideline for Use of Glucarpidase in Patients With High‐Dose Methotrexate Induced Acute Kidney Injury and Delayed Methotrexate Clearance.

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Highlights - Consensus Guidelines

Highlighted excerpts from the Consensus Guideline for Use of Glucarpidase in Patients With High-Dose Methotrexate Induced Acute Kidney Injury and Delayed Methotrexate Clearance.

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Voraxaze® (glucarpidase) Treatment Algorithm

Download and print for your practice: Treatment algorithm based on the Consensus Guidelines.

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Expert Consensus Stocking Guidelines

Review the stocking guidelines established by an international expert panel.

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Educational and Downloadable Tools

Early Warning Signs of Delayed Methotrexate (MTX) Clearance

Download this resource to help you identify the early warning signs of delayed MTX clearance.

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Voraxaze 5-Minute Educational Video

Watch and learn about the importance of identifying delayed methotrexate (MTX) clearance and acute kidney injury early, and when to use Voraxaze® (glucarpidase).

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HDMTX Roadmap for Success

Download this resource to guide you through successful management of delayed methotrexate (MTX) clearance in patients being treated with high-dose MTX (HDMTX).
 

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Expert Discussions

OncLive® Webinar

Watch leading experts discuss the current landscape of high-dose methotrexate (HDMTX) toxicity and treatment options to improve patient outcomes.

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Consensus Guideline Expert Interview

Watch and listen to experts discuss important information about guidelines for managing patients with delayed methotrexate (MTX) clearance due to renal impairment.

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JADPRO CE: Clinical Updates in Acute Kidney Injury

Review the management of delayed methotrexate (MTX) clearance due to acute kidney injury according to published clinical guidelines using two certified case-based activities about high-dose MTX (HDMTX) toxicity created for oncology advanced practitioners.

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Clinical Articles

Annals of Emergency Medicine

Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care
Dart RC et al, 2018.
Review recommendations of an expert panel for the stocking of antidotes, including Voraxaze® (glucarpidase), in emergency departments.

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Cancer

Resumption of High-Dose Methotrexate After Acute Kidney Injury and Glucarpidase Use in Pediatric Oncology Patients
Christensen AM et al, 2012.
The authors report on clinical data and outcomes in pediatric patients who received Voraxaze® (glucarpidase) after treatment with high-dose methotrexate (HDMTX).



High-Dose Methotrexate-Induced Nephrotoxicity in Patients With Osteosarcoma
Widemann BC et al, 2004.
This review of trials in patients with osteosarcoma and high-dose methotrexate (HDMTX)-induced acute kidney injury compares the efficacy of dialysis-based methods and time to renal recovery after supportive treatment with efficacy and renal recovery after treatment with Voraxaze® (glucarpidase).

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Clinical Pharmacology & Therapeutics

MTXPK.org: A Clinical Decision Support Tool Evaluating High-Dose Methotrexate Pharmacokinetics to Inform Post-Infusion Care and Use of Glucarpidase
Taylor ZL et al, 2020.
Overview of a web-based clinical decision support tool that helps clinicians monitor whether patients are clearing methotrexate (MTX) as expected.

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Clinical Toxicology

Pooled Analysis of Time to Administration of Glucarpidase for Methotrexate Toxicity Versus Mortality
Ward S et al, 2013.
A pooled analysis of data from 476 patients with high-dose methotrexate (HDMTX)-induced renal toxicity and delayed MTX clearance who received treatment with Voraxaze® (glucarpidase) that examines overall mortality based on days between start of HDMTX infusion and first Voraxaze dose. (Abstract #7)

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ClinicoEconomics and Outcomes Research

Length of Stay, Mortality, and Readmissions Among Medicare Cancer Patients Treated With Glucarpidase and Conventional Care: A Retrospective Study
Demiralp B et al, 2019.
Examines hospital length of stay, mortality, and readmission rates for Medicare cancer patients with delayed clearance of methotrexate (MTX) treated with Voraxaze® (glucarpidase).

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Journal of Clinical Oncology

Glucarpidase, Leucovorin, and Thymidine for High-Dose Methotrexate-Induced Renal Dysfunction: Clinical and Pharmacologic Factors Affecting Outcomes
Widemann BC et al, 2010.
An analysis of the role of Voraxaze® (glucarpidase), leucovorin, and thymidine in the management and outcomes of patients with high-dose methotrexate (HDMTX)-induced renal dysfunction, including factors associated with development of Grade 4 or fatal toxicity in these patients.



High-Dose Methotrexate in Patients With Lymphoma: Predictors of a Complicated Course
O’Donoghue et al., 2022
This retrospective analysis comprised of 642 adult patients with lymphoma with 2,804 cycles of HDMTX. The incidence of AKI was 19.1% with AKI grade ≥ 2 making up 21% of cases. Rates of AKI, ICU admission, and 30-day mortality are associated with elevated 48-hour MTX levels. There was a significant increase in median LOS with elevated MTX levels (P < .001). Receiver operator characteristic curve analysis for AKI grade ≥ 2 demonstrated a 48-hour MTX level threshold of 1.28 μmol/L. Multivariate logistic regression analysis revealed age, male sex, elevated body surface area, higher MTX dose, monotherapy, and first cycle as independent factors.

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Pediatric Blood & Cancer

Delayed Elimination of High-Dose Methotrexate and Use of Carboxypeptidase G2 in Pediatric Patients During Treatment for Acute Lymphoblastic Leukemia
Svahn T et al, 2016.
A report on pediatric patients with acute lymphoblastic leukemia who were treated between 2008–2014 according to the Nordic Organization for Pediatric Hematology and Oncology (NOPHO) ALL 2008 protocol, which includes administration of 6-8 high-dose methotrexate (HDMTX) courses as well as recommendations for intervention with Voraxaze® (glucarpidase) in the presence of delayed MTX clearance.

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The Oncologist

Consensus Guideline for Use of Glucarpidase in Patients With High-Dose Methotrexate Induced Acute Kidney Injury and Delayed Methotrexate Clearance
Ramsey LB et al, 2018.
Expert Consensus Guidelines for the timely and effective use of Voraxaze® (glucarpidase) to treat high-dose methotrexate (HDMTX)-induced acute kidney injury and delayed MTX clearance, including supportive care and MTX monitoring before and after treatment.



Preventing and Managing Toxicities of High-Dose Methotrexate
Howard SC et al, 2016.
An overview of the literature regarding high-dose methotrexate (HDMTX) therapy and risk for associated toxicities – including comprehensive recommendations for prevention and management of toxicity and treatment guidance for HDMTX-induced acute kidney injury.

 

Glucarpidase (Carboxypeptidase G2) Intervention in Adult and Elderly Cancer Patients With Renal Dysfunction and Delayed Methotrexate Elimination After High-Dose Methotrexate Therapy
Schwartz S et al, 2007.
A review of the potential risks involved in cancer treatment with high-dose methotrexate (HDMTX), including acute kidney injury and delayed MTX clearance, and evaluation of rescue intervention with Voraxaze® (glucarpidase).



Understanding and Managing Methotrexate Nephrotoxicity
Widemann BC et al, 2006.
Review the pharmacology of methotrexate (MTX), incidence of high-dose MTX–induced renal impairment, and various approaches to treatment, including conventional supportive care and leucovorin rescue, dialysis-based methods, and Voraxaze® (glucarpidase).

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