Pharmacist-driven MTX protocol reduces length of stay, kidney injury

Implementing a pharmacist-driven protocol for high-dose methotrexate (MTX) management leads to a significant decrease in inpatient length of stay and kidney injury, according to a study.

“Delayed MTX clearance in several patients admitted to the oncology unit at a regional medical centre necessitated the development of a pharmacist-driven protocol for supportive therapy with high-dose MTX,” the investigators said.

This study collected retrospective data over 14 months preimplementation as well as prospective data over 19 months postimplementation. Chi-squared and unpaired two sample t-test were used to analyse data. Mean length of stay and incidence of kidney injury were the primary outcomes. Secondary ones included myelosuppression, treatment delays, mucositis, protocol adherence, and pharmacist interventions.

In addition, the investigators conducted a literature review of consensus recommendations for supportive care after high-dose MTX administration to develop protocol. Education on implementation was provided to involved disciplines.

The analysis included 110 high-dose MTX admissions for 23 patients: 24 preprotocol and 86 postprotocol. Mean length of stay was 5.17 nights preprotocol and 3.91 nights postprotocol (p=0.026).

Kidney injury incidence significantly dropped (16.7 percent preprotocol vs 3.5 percent postprotocol; p=0.0394). There was also a marked decrease in the incidences of the following postprotocol: all-grade anaemia (83.3 percent vs 58.1 percent), neutropaenia (62.5 percent vs 29.1 percent), thrombocytopaenia (58.3 percent vs 33.7 percent), and treatment delays (29.2 percent vs 11.6 percent; p=0.036). Incidence of mucositis did not differ significantly.

Adherence by pharmacists to the protocol was ≥80 percent, resulting in 348 interventions with 99.4 percent provider acceptance.

“Further studies are needed to assess the impact on additional outcomes,” the investigators said.