A news story recently in the New York Times has unveiled a growing concern among pediatric oncologists and health care institutions at large. The injectable form of preservative free methotrexate, commonly used to treat pediatric patients with leukemia and osteosarcoma, is in short supply.
The bigger drug shortage picture
Drug shortages are an increasingly frequent and serious problem affecting health care organizations across the country.
"A number of contributing factors are causing these shortages, such as raw material unavailability, manufacturing difficulties and regulatory issues, voluntary recalls related to manufacturing problems, changes in medication formulation, and industry consolidations and economic decisions," says Wendy Heck, Pharm.D., manager of drug information and drug use policy at MD Anderson Cancer Center.
Regardless of the cause, drug shortages create great frustration for everyone involved, including purchasing agents, pharmacists, nurses, physicians, and patients. Fortunately, not all national drug shortages will go on to affect MD Anderson.
"We meet weekly to review current drug shortages. If a shortage does reach MD Anderson, our team works diligently to develop a management plan to minimize the impact on our patients," says Joel Lajeunesse, vice president of the Division of Pharmacy. "For now, we have sufficient supplies of methotrexate for our patients."
Managing the supply of methotrexate at MD Anderson
Pediatric oncologists at MD Anderson Children's Cancer Hospital work closely with pharmacists to manage the supply of methotrexate for pediatric patients. The most recent concern involves the preservative free form of injectable methotrexate. This form is commonly used for intrathecal, or spinal cord, injections because it lowers the risk for neurotoxicities, such as paralysis.
"We've been dealing with drug shortages in pediatric oncology for a while now, whether it stems from lack of development or discontinuation of production," says Patrick Zweidler-McKay, M.D., Ph.D., section chief of leukemia at the Children's Cancer Hospital. "It's not as profitable for companies to make drugs for rarer cancers, such as childhood cancer. However, this situation involves vital standard-of-care drugs, and we can't get a consistent supply of them. Something must be done for our patients' sake."