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:
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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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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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).
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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Consensus Guideline for Use of Glucarpidase in Patients With High‐Dose Methotrexate Induced Acute Kidney Injury and Delayed Methotrexate Clearance.
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Highlighted excerpts from the Consensus Guideline for Use of Glucarpidase in Patients With High-Dose Methotrexate Induced Acute Kidney Injury and Delayed Methotrexate Clearance.
Download PDF: Highlights - Consensus Guidelines
Download and print for your practice: Treatment algorithm based on the Consensus Guidelines.
Download PDF: Voraxaze (glucarpidase) Treatment Algorithm
Review the stocking guidelines established by an international expert panel.
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Download this resource to help you identify the early warning signs of delayed MTX clearance.
Download PDF: Early Warning Signs of Delayed MTX Clearance
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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Download this resource to guide you through successful management of delayed
methotrexate (MTX) clearance in patients being treated with high-dose MTX
(HDMTX).
Hear Matthew’s story of how Voraxaze was ordered, delivered, and administered in his time of need.
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Hear Matthew’s story, an osteosarcoma survivor who received Voraxaze during his cancer treatment. Matthew successfully completed his treatments and paved the way for a cancer-free life.
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Hear Dr. Matteo Trucco discuss the importance and risks of methotrexate in MAP chemotherapy and how Voraxaze effectively counters methotrexate toxicity, preventing further toxicity and ensuring patient safety.
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Discover Dr. Kurt Weiss’ insights on the importance of completing MAP chemotherapy with consideration to surgery with osteosarcoma patients and the vital role of Voraxaze in treating methotrexate toxicity.
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Watch leading experts discuss the current landscape of high-dose methotrexate (HDMTX) toxicity and treatment options to improve patient outcomes.
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Watch and listen to experts discuss important information about guidelines for managing patients with delayed methotrexate (MTX) clearance due to renal impairment.
Watch VideoExpert 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.
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).
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More
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).
High-Dose Methotrexate: Nurse Considerations for Administration and
Supportive Care
Roche et al., 2023.
This article provides an overview of High-Dose Methotrexate (HDMTX)
treatment and nursing considerations, including HDMTX toxicities, components
of supportive care, and strategies to manage HDMTX administration and
delayed elimination.
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.
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)
Glucarpidase for Treating Adults with Delayed Methotrexate
Elimination Due to Impaired Renal Function: An Economic Simulation
Analysis
Kala JK, et al., 2023
A decision tree model was developed to assess the economic impact of
glucarpidase. Treatment of all eligible patients with glucarpidase within 60
hours was associated with an increased cost per patient (relative to current
practice) but substantial improvements in clinical outcomes. Timely
glucarpidase use was less expensive than delayed glucarpidase or
hemodialysis.
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More
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).
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.
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More
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.
Acute kidney injury associated with high dose methotrexate
Mamlouk O., et al., 2019
A 46 year-old man with high-grade B cell lymphoma was admitted for
treatment with rituximab and high dose methotrexate (MTX). The patient was
started on intravenous (IV) fluid with sodium bicarbonate for volume
expansion and alkalization of urine, then 3.5 g/m2 of MTX was infused
over 4 h. Serum creatinine (SCr) prior to infusion was of
1.1 mg/dL and increased to 1.24 and 4.5 mg/dL at 12 and
36 h after the infusion, respectively. The patient was diagnosed with
methotrexate-induced crystalline nephropathy. This article shows images of
MTX crystals from the urine of affected patients that show its detailed
structure.
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.
Methotrexate Level Discrepancy Post-Glucarpidase: A Pediatric Case Series and Review of Literature
Kibby D, Trinkman H, 2024.
Laboratory interference with immunoassay measurement post-glucarpidase administration is well
established, with current product labeling indicating this persists for 48 h.
However, recent experience in pediatric patients supports this discrepancy persists beyond 48 h.
Three cases experienced delayed methotrexate clearance and received glucarpidase with subsequent
measurement of methotrexate levels by liquid chromatography tandem mass spectrometry (LC‑MS/MS)
and/or immunoassay. Within this case series, discrepancies between LC‑MS/MS and immunoassay
levels persisted significantly longer than 48 h.
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.
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More
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.
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More
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).
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More
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).