A retrospective analysis of methotrexate safety data indicates injection of the disease-modifying anti-rheumatic drug is not superior to oral therapy in the long-term treatment of patients with juvenile idiopathic arthritis.
“Our analysis found that efficacy and tolerability of [methotrexate] MTX was similar in both delivery methods,” lead author Ariane Klein, MD, stated in a news release. “The often-unpopular MTX injection did not appear to be superior to oral administration, and may likely be spared without clinical consequences.”
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The findings, published in Arthritis Care & Research, suggest that the more comfortable oral approach, due to its similar efficacy and tolerability, may be more suitable to treat patients with pediatric arthritis.
According to the study abstract, the authors worked with inclusion criteria of a juvenile idiopathic arthritis diagnosis, MTX treatment for 6 months or more, consistent MTX administration route and no previous or concomitant biologic treatment. PedACR scores were used to determine treatment efficacy, with the primary outcome being efficacy determined through the number of patients reaching PedACR 30 criteria following 6 months of treatment.
In all, according to the release, the study groups consistent of 259 patients (63%) who received oral MTX and 152 patients (32%) who received MTX injections. In both groups, patients had a median age of 10 years. All patients received a comparable dose of MTX.
After 6 months, efficacy was determined to be 72% in the oral therapy group and 73% in the group receiving injections. At least one adverse event was reported in 22% of patients in the oral therapy cohort, compared to 27% in the injection therapy group. The authors noted that significantly more patients in the MTX injection group discontinued their treatment due to adverse events (11%, compared to 5% in the oral therapy cohort).
- Klein A, Kaul I, Foeldvari I, et al. Efficacy and safety of oral and parenteral methotrexate therapy in children with juvenile idiopathic arthritis. Arthritis Care Res. 2012. doi:10.1002/acr.21697