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Efficacy and safety of methotrexate therapy for juvenile rheumatoid arthritis
1Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Oral methotrexate (MTX) is an effective and safe treatment for juvenile rheumatoid arthritis (JRA) in Taiwanese children. This therapy helps improve symptoms and allows for reduced corticosteroid use, with manageable side effects.
Area of Science:
- Pediatric Rheumatology
- Pharmacological Treatments for Autoimmune Diseases
- Clinical Efficacy and Safety Studies
Background:
- Juvenile rheumatoid arthritis (JRA) poses significant risks including disability, growth disturbances, and systemic complications in children.
- Effective therapeutic strategies are crucial for managing JRA and preventing long-term adverse outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety profile of oral methotrexate (MTX) in Taiwanese pediatric patients diagnosed with JRA.
- To assess MTX as a second-line treatment option for JRA when initial therapies have proven insufficient.
Main Methods:
- Retrospective analysis of medical records from 52 Taiwanese children with JRA treated with oral MTX.
- Patients had varying JRA subtypes (polyarticular, oligoarticular, systemic) and prior treatment failures, including NSAIDs, hydroxychloroquine, and sulfasalazine.
- Dosing, duration of MTX treatment (mean 23 months), and follow-up (mean 52 months) were analyzed.
Main Results:
- Significant clinical improvement observed in 69% (36/52) of children, with 48% (25/52) achieving clinical remission.
- MTX therapy facilitated corticosteroid dose reduction in 6 children and complete discontinuation in 10 children.
- Adverse effects were reported in 25% (13/52) of patients but were generally mild and resolved with dose adjustment or cessation.
Conclusions:
- Oral methotrexate (MTX) demonstrates considerable efficacy and a favorable safety profile for treating JRA in Taiwanese children.
- MTX is recommended as a primary choice for second-line therapy in pediatric JRA management.
Background And Purpose:
Juvenile rheumatoid arthritis (JRA) can result in disability, growth disturbance, and systemic complications. This study investigated the efficacy and adverse effects of oral methotrexate (MTX) therapy in Taiwanese children with JRA.
Methods:
The medical records of 52 Taiwanese children with JRA treated with oral MTX were retrospectively analyzed. The disease onset was polyarticular in 22 children, oligoarticular in 13, and systemic in 17. The indication for MTX therapy was lack of efficacy of previous drugs, including two or more nonsteroidal anti-inflammatory drugs, in all patients. In addition, three patients had received hydroxychloroquine and one had received sulfasalazine, without improvement. Corticosteroid dependency had developed in 27 patients prior to MTX therapy. The mean initial dose of MTX was 9.1 mg.m-2.wk-1 (range, 5-20 mg.m-2.wk-1), and the mean maximal dose was 10.2 mg.m-2.wk-1 (range, 5-20 mg.m-2.wk-1). The mean duration of treatment was 23 months (range, 6-96 mo), and the mean duration of follow-up was 52 months (range, 10-123 mo) from the start of MTX therapy.
Results:
Thirty-six children (69%) showed clinical improvement and 25 children (48%) achieved clinical remission. The administration of MTX resulted in more than a 50% reduction in required corticosteroid dosage in six children, and complete discontinuation of corticosteroid in 10 children. MTX was discontinued in 18 patients following a mean of 8 months (range, 2-34 mo) of clinical remission. Relapse occurred in nine (50%) of these patients. Thirteen patients (25%) suffered from adverse effects associated with MTX treatment. All of these adverse effects resolved spontaneously, or subsided within 4 weeks following dosage reduction or discontinuation of MTX.
Conclusions:
Oral MTX therapy is effective and well-tolerated in Taiwanese children with JRA. It can serve as the first choice of second-line therapy in JRA.