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Role of Ondansetron in Reducing Methotrexate Intolerance in Patients with Inflammatory Arthritis

Saba Saif1, Spenta Kakalia2, Rizwana Kitchlew1

  • 1Department of Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore Cantt, Pakistan.

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
|October 7, 2022
PubMed
Abstract

Insights

Methotrexate intolerance affects over a quarter of inflammatory arthritis patients, with nausea being the main symptom. Ondansetron significantly reduces this intolerance, particularly nausea and vomiting, in patients with inflammatory arthritis.

Area of Science:

  • Rheumatology
  • Clinical Pharmacology

Background:

  • Methotrexate (MTX) is a cornerstone therapy for inflammatory arthritis.
  • MTX intolerance, characterized by symptoms like nausea, can limit treatment adherence and efficacy.
  • Quantifying MTX intolerance and exploring mitigation strategies are crucial for patient management.

Purpose of the Study:

  • To determine the frequency of Methotrexate intolerance in patients with inflammatory arthritis using the MTX intolerance severity score (MISS).
  • To evaluate the efficacy of Ondansetron in reducing MTX intolerance, specifically nausea and vomiting.

Main Methods:

  • An interventional study was conducted in a rheumatology clinic involving 181 patients with inflammatory arthritis on MTX for over 3 months.
  • MTX intolerance was assessed using the MISS questionnaire.
  • Patients with MTX intolerance experiencing nausea and vomiting were treated with Ondansetron concurrently with MTX and followed for 3 months.

Main Results:

  • Methotrexate intolerance was observed in 26.5% (48/181) of patients.
  • Nausea was the predominant symptom (93.8%), followed by behavioral symptoms like restlessness (79%) and irritability (77%).
  • Ondansetron treatment led to a significant reduction in the median MISS score within two months (p <0.05), with sustained benefits at three months.

Conclusions:

  • Methotrexate intolerance is common in inflammatory arthritis patients.
  • Ondansetron effectively reduces MTX-associated intolerance, particularly nausea and vomiting, improving patient outcomes.

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