Summary

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• Glucarpidase (Voraxaze) is indicated for the treatment of toxic plasma methotrexate concentrations (>1 micromole per liter) in patients with delayed methotrexate clearance due to impaired renal function.
• The systematic review analyzed a total of 92 articles, including data from 90 patients with impaired renal function and toxic methotrexate plasma concentrations.
• Voraxaze (glucarpidase), used alongside supportive treatments like intravenous hydration and folinic acid, showed superior effectiveness in rapidly removing methotrexate compared to extracorporeal treatments.
• Extracorporeal treatments were less effective than glucarpidase in reducing methotrexate levels quickly and are generally recommended against by the EXTRIP workgroup when glucarpidase is available or already administered.
• Safety considerations favor Voraxaze (glucarpidase) over extracorporeal methods due to fewer complications associated with its use under monitored conditions. No specific adverse events were mentioned for glucarpidase within the study reviewed.
• Population types primarily involve patients experiencing high-dose (>0.5 g/m2) or low-dose (<0.5 g/m2) methotrexate toxicity due to impaired renal function, highlighting subgroup-specific recommendations based on these patient groups' needs.