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[Methotrexate in juvenile idiopathic arthritis. Adverse effects and associated factors]

Estefanía Barral Mena1, Luis Miguel García Cárdaba2, Anna Canet Tarrés2

  • 1Servicio de Pediatría, Hospital Universitario Infanta Leonor, Madrid, España.

Anales De Pediatria
|November 9, 2019
PubMed
Abstract

Insights

Methotrexate (MTX) is a common treatment for juvenile idiopathic arthritis, but nearly half of children experience adverse effects (AEs). These AEs, often gastrointestinal or behavioral, can lead to treatment interruption in a significant portion of young patients.

Area of Science:

  • Pediatric Rheumatology
  • Pharmacovigilance
  • Clinical Pharmacology

Background:

  • Methotrexate (MTX) is the primary pharmacologic agent for juvenile idiopathic arthritis (JIA).
  • Clinical effectiveness of MTX in JIA is frequently compromised by the occurrence of adverse effects (AEs).

Purpose of the Study:

  • To investigate the incidence and types of adverse effects (AEs) associated with methotrexate (MTX) therapy in pediatric patients diagnosed with juvenile idiopathic arthritis (JIA).
  • To identify risk factors for developing AEs and assess the impact of AEs on treatment continuation in JIA patients.

Main Methods:

  • A retrospective observational study design was employed.
  • Data were collected from 107 pediatric patients with JIA treated with MTX between 2008 and 2016 at a tertiary hospital.
  • AEs, patient demographics, clinical characteristics, and treatment modifications were analyzed.

Main Results:

  • Nearly half of the patients (48.6%) developed AEs, most commonly gastrointestinal symptoms and behavioral problems.
  • Increased age at therapy initiation (over 6 years) was a significant risk factor for AEs (OR=3.5).
  • AEs led to MTX discontinuation in 34.6% of patients, primarily due to elevated transaminases, GI issues, or behavioral problems.

Conclusions:

  • Methotrexate (MTX) is a crucial treatment for juvenile idiopathic arthritis (JIA), but its use is associated with significant adverse effects (AEs) in approximately 50% of pediatric patients.
  • While often not severe, these AEs frequently necessitate treatment modification or interruption in a substantial number of children (35%).
  • Age at initiation of therapy is a key factor influencing AE development, highlighting the need for careful monitoring in older children starting MTX.
Keywords:
Adverse effectsArtritis juvenilEfectos adversosHipertransaminasemiaIntoleranciaJuvenile arthritisMethotrexateMetotrexatoVomiting

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