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Methotrexate intolerance in oral and subcutaneous administration in patients with juvenile idiopathic arthritis: a

E H Pieter van Dijkhuizen1, Juliëtte N Pouw2, Andrea Scheuern3

  • 1University Medical Center Utrecht, The Netherlands; and IRCCS G. Gaslini, Genoa, Italy. e.h.p.dijkhuizen@umcutrecht.nl.

Clinical and Experimental Rheumatology
|February 5, 2016
PubMed
Abstract

Insights

Methotrexate intolerance is common in juvenile idiopathic arthritis patients, affecting over 40%. Exclusively subcutaneous methotrexate administration was linked to higher intolerance and behavioral issues compared to oral routes.

Area of Science:

  • Rheumatology
  • Pediatric Rheumatology
  • Pharmacology

Background:

  • Methotrexate (MTX) is a primary disease-modifying anti-rheumatic drug (DMARD) for juvenile idiopathic arthritis (JIA).
  • Previous studies in Dutch patients indicated frequent MTX intolerance, particularly with subcutaneous (SC) administration.
  • The association between MTX administration route and intolerance in German JIA patients requires investigation.

Purpose of the Study:

  • To determine the prevalence of MTX intolerance in a German cohort of JIA patients.
  • To assess the association between MTX intolerance and the route of administration (subcutaneous vs. oral).
  • To compare gastrointestinal adverse effects between SC and PO MTX administration.

Main Methods:

  • A cross-sectional study design was employed.
  • Methotrexate Intolerance Severity Score (MISS) questionnaire used to assess MTX intolerance.
  • Prevalence of MTX intolerance and gastrointestinal adverse effects compared between SC and PO MTX groups.

Main Results:

  • Out of 179 JIA patients on MTX, 73 (40.8%) reported intolerance.
  • Patients using exclusively SC MTX had significantly higher odds of MTX intolerance (aOR 3.37).
  • SC MTX was associated with more behavioral complaints (76.1% vs. 47.4%) and similar rates of abdominal pain compared to PO MTX.

Conclusions:

  • High prevalence of MTX intolerance observed in German JIA patients.
  • Exclusively SC MTX administration is linked to increased MTX intolerance and behavioral adverse effects.
  • The assumption that SC MTX causes fewer side effects than PO MTX is not supported; further randomized trials are needed.

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