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Allopurinol, the first-line ULT, suffers from reduced efficacy in patients with impaired conversion to its active metabolite, oxypurinol (OXY), and carries risks of severe hypersensitivity reactions (Mohamad et al., 2025
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5.4 Myelosuppression Methotrexate suppresses hematopoiesis and can cause severe and life-threatening pancytopenia, anemia, aplastic anemia, leukopenia, neutropenia, and thrombocytopenia [see Adverse Reactions ( 6.1)]
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