injectible MTX in JIA better absorbed/better results

[Mike Bartolatz]

Subcutaneous Methotrexate Effective in Juvenile Idiopathic Arthritis



NEW YORK (Reuters Health) Feb 26 - Subcutaneous methotrexate is effective in treating patients with juvenile idiopathic arthritis (JIA) for whom oral therapy with methotrexate has failed, according to a new study. Four of 31 children on the medication experienced transient liver enzyme abnormalities or mild lymphopenia that resolved after temporary discontinuation of treatment and did not recur when therapy was reinstituted.

Methotrexate is widely used to treat children with arthritis, the authors explain, but its bioavailability often does not increase when doses exceed 20 mg per square meter per week.

Dr. Peter N. Malleson and colleagues from University of British Columbia, Vancouver, British Columbia, Canada switched 31 of 61 patients with JIA from oral to subcutaneous methotrexate and assessed outcomes after treatment. Thirteen were switched because of lack of efficacy, and 18 were switched because of persistent nausea or insufficient clinical improvement.

Twenty-three of 30 patients switched to subcutaneous methotrexate for whom sufficient data were available experienced significant improvement when compared to values obtained after 3 months of maximum dose oral methotrexate, the authors report.

Overall, patients switched to subcutaneous methotrexate experienced significant improvements in physician global assessment of disease activity, number of joints with limited range of movement, early morning stiffness, and erythrocyte sedimentation rate.

Nine of 11 patients switched to subcutaneous methotrexate because of nausea with the oral administration had complete resolution of their nausea, the results indicate, and the other 2 had less severe nausea after the switch.

The report appears in the January issue of The Journal of Rheumatology.

"Our study has the limitations of being retrospective in design," the authors conclude. "Nevertheless, we believe that as each child acts as his/her own control, the results of this study are fairly robust and that the majority of children with JIA who are inadequately responsive to oral methotrexate will improve significantly without increased toxicity after switching to subcutaneous methotrexate."

J Rheumatol 2004;31:179-182.


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Subject: [JRA] The Role of Subcutaneous Administration of MTX in Children w/
JRA Who Have Failed Oral Methotrexate


> The Role of Subcutaneous Administration of Methotrexate in Children with
> Juvenile Idiopathic Arthritis Who Have Failed Oral Methotrexate
> http://www.jrheum.com/abstracts/abstracts04/179.html
>
> KHAYRIAH ALSUFYANI, OLIVA ORTIZ-ALVAREZ, DAVID A. CABRAL, LORI B.
> TUCKER, ROSS E. PETTY, and PETER N. MALLESON
>
> ABSTRACT.
>
> Objective. To describe the outcome of patients with juvenile idiopathic
> arthritis (JIA) treated with subcutaneous (Sc) methotrexate (MTX) after
> failing oral MTX (either because of inefficacy or toxicity) in a clinic
> population.
>
> Methods. The study cohort was identified from our clinical database, and
> consisted of 61 children with JIA treated with MTX between 1988-2001.
> All patients fulfilled International League Against Rheumatism (ILAR)
> criteria for JIA and had disease duration of ³ 6 months and 3 or more
> active joints before institution of MTX. All patients had a core set of
> outcome variables assessed at baseline and at 3 months after achieving
> both maximum oral and SC MTX. Outcome variables included physician
> global assessment of disease activity, number of active joints, number
> of joints with limited range of motion, duration of early morning
> stiffness, and erythrocyte sedimentation rate (ESR). Improvement was
> defined as at least 30% improvement from baseline in 3 of 5 variables in
> the core set, with no more than one of the remaining variables worsening
> by more than 30%.
>
> Results. A total of 61 patients, 43 females and 18 males with JIA were
> studied. The disease subtypes were systemic 8, polyarticular 25 (12
> rheumatoid factor positive), oligoarticular 14, enthesitis related
> arthritis 5, and unclassified 4. Thirty-one patients were switched to SC
> MTX, 13 of whom had not improved, and 18 who had improved, but had
> nausea (11) or insufficient clinical improvement (7). After 3 months of
> SC MTX treatment, 76% of patients were classified as improved and 23% as
> not improved. Toxicity on SC MTX was less than on oral MTX.
>
> Conclusion. Our results suggest that for patients failing oral MTX
> either because of inefficacy or toxicity, the use of SC MTX has a high
> likelihood of success with more than 70% of patients achieving
> clinically significant improvement, without clinically significant
> toxicity. (J Rheumatol 2004;31:179-82)
>
> Key Indexing Terms:
> JUVENILE IDIOPATHIC ARTHRITIS
> METHOTREXATE
> TREATMENT
>
> From the Division of Rheumatology, Department of Pediatrics, University
> of British Columbia, Vancouver, BC, Canada.
>
> K. Alsufyani, MD, Research Fellow; O. Ortiz-Alvarez, MD, Research
> Associate; D.A. Cabral, MBBS, FRCPC, Clinical Assistant Professor; L.B.
> Tucker, MD, FAAP, Clinical Associate Professor; R.E. Petty, MD, PhD,
> FRCPC, Professor of Pediatrics; P.N. Malleson, MBBS, MRCP(UK), FRCPC,
> Professor of Pediatrics.
>
> Address reprint requests to Dr. P. Malleson, Room K4-122, B.C.'s
> Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada.
>
>
>

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