Intolerance of oral methotrexate in juvenile idiopathic arthritis.

IF 1 4区医学 Q3 PEDIATRICS

Pediatrics International Pub Date : 2025-01-01 DOI:10.1111/ped.70112

Ai Yuda, Tomo Nozawa, Seira Hattori, Ayako Murase, Kenichi Nishimura, Ryoki Hara, Shuichi Ito

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引用次数: 0

Abstract

Background: Oral methotrexate (MTX) is a cornerstone treatment for juvenile idiopathic arthritis (JIA), although adverse events (AEs) such as nausea and vomiting often impact adherence. This study examined the intolerability of MTX in patients with JIA.

Methods: We retrospectively investigated MTX intolerability in 52 patients treated at our institute between April 2011 and October 2022. The target MTX dose was 10 mg/m²/week (maximum 16 mg/week) according to the Japanese clinical guidelines for JIA.

Results: The median age at MTX initiation was 8.3 years, with a median maximum dose of 8.9 mg/m²/week. Of the 52 patients, 16 (31%) were started on biologics before or at the initiation of MTX, while 36 (69%) began MTX monotherapy. Fifteen (29%) patients could not reach the target MTX dose because of AEs. Thirty-six (68%) patients experienced one or more AEs, with nausea and vomiting being the most common (n = 24). Eleven patients (21%) failed to achieve or maintain remission because of intractable nausea/vomiting, and nine (17%) eventually required biologics. Among the 24 patients who experienced nausea/vomiting, 42% developed symptoms within 6 months and 67% within 12 months of MTX initiation. AEs occurred regardless of MTX dose.

Conclusions: Two-thirds of patients experienced AEs with oral MTX, leading some to fail remission and require biologics. Intolerability of oral MTX was common and significantly influenced patient outcomes.

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口服甲氨蝶呤治疗青少年特发性关节炎的不耐受。

背景：口服甲氨蝶呤（MTX）是青少年特发性关节炎（JIA）的基础治疗，尽管恶心和呕吐等不良事件经常影响依从性。本研究探讨甲氨蝶呤在JIA患者中的不耐受性。方法：我们回顾性调查了2011年4月至2022年10月期间在我所治疗的52例MTX不耐受患者。根据日本JIA临床指南，目标MTX剂量为10mg /m2/周（最大16mg /周）。结果：MTX起始时的中位年龄为8.3岁，中位最大剂量为8.9 mg/m2/周。在52例患者中，16例（31%）在MTX开始前或开始时开始使用生物制剂，而36例（69%）开始使用MTX单药治疗。15例（29%）患者由于不良反应未能达到MTX的目标剂量。36例（68%）患者出现一次或多次不良反应，其中恶心和呕吐最为常见（n = 24）。11名患者（21%）由于难治性恶心/呕吐而未能达到或维持缓解，9名患者（17%）最终需要生物制剂。在24例出现恶心/呕吐的患者中，42%在MTX开始治疗的6个月内出现症状，67%在12个月内出现症状。无论甲氨蝶呤的剂量如何，都会发生不良反应。结论：三分之二的患者口服甲氨蝶呤出现不良反应，导致一些缓解失败，需要生物制剂。口服甲氨蝶呤的不耐受性是常见的，并显著影响患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatrics International 医学-小儿科

CiteScore

2.00

自引率

7.10%

发文量

519

审稿时长

12 months

期刊介绍： Publishing articles of scientific excellence in pediatrics and child health delivery, Pediatrics International aims to encourage those involved in the research, practice and delivery of child health to share their experiences, ideas and achievements. Formerly Acta Paediatrica Japonica, the change in name in 1999 to Pediatrics International, reflects the Journal''s international status both in readership and contributions (approximately 45% of articles published are from non-Japanese authors). The Editors continue their strong commitment to the sharing of scientific information for the benefit of children everywhere. Pediatrics International opens the door to all authors throughout the world. Manuscripts are judged by two experts solely upon the basis of their contribution of original data, original ideas and their presentation.