Pediatric Rheumatology Online Journal → June 2003 → Methotrexate→ Abstract #45

THE ROLE OF SUBCUTANEOUS METHOTREXATE IN CHILDREN WITH JIA WHO HAVE FAILED ORAL METHOTREXATE

Khariah A. Alsufyani,¹ Oliva Ortiz-Alvarez,¹ Peter N. Malleson,¹ David A. Cabral,¹ Lori B. Tucker,¹ Ross E. Petty.¹

¹Pediatric Rheumatology, University of British Columbia, Childrens Hospital, Vancouver, BC, Canada

Background: Although Methotrexate (MTX) is now the most widely used DMARD in the treatment of JIA, there is little data on whether switching to subcutaneous (SQ) administration is effective in pts who have failed oral MTX.
Objective: To describe the outcome of pts with JIA treated with SQ MTX after failing oral MTX in a clinic population.
Patients and Methods: 61 pts fulfilled ILAR criteria for JIA and had disease duration 6 month, and 3 active joints before institution of MTX. 31 pts were switched to SQ . Improvement was defined as occurring if there was improvement by at least 30% in any 3 of 5 variables (physician global assessment of disease activity (PGA), number of active joints, number of joints with limited motion, ESR, and duration of early morning stiffness in minutes) with no more than one variable worsening by 30%. Pts were studied at onset of MTX and at 3 months after achieving maximum oral and maximum SQ MTX.
Results: A total of 61 JIA patients were studied. Mean age at time of treatment with oral MTX was 11.9 yrs (+/- 4.3, range 3 to 20 years), mean age at onset of JIA was 11.4(+/- 2, range 1.6 to 16 years), mean disease duration was 0.9 yrs (+/- 1.5, range 0.2 to 8.3yrs). Systemic: 8, polyarticular: 25 ; oligoarticular: 14, enthesitis related arthritis: 5, and unclassified: 4. 40/58 (69%) fulfilled criteria for improvement after oral MTX (mean for maximum oral dose was 13.8 +/- 4.3, range 5 to 15 mg/m2/wk). 19/27 (70%) of the pts who failed oral MTX later improved after switching to SQ MTX (mean for maximum SQ dose was 15.42 +/- 4.4, range 5 to 15 mg/m2/ wk). Looking at number of pts who improved by 30% for each variable separately: PGA 24/27(89%), Active joint count 23/27 (85%), Limitation of movement 17/27 (63%), ESR 26/27 (96%), Early morning stiffness 16/27 (59%).
Conclusions: This study suggests that for pts failing oral MTX , the use of SQ MTX has a high likelihood of success with 70% of pts achieving significant clinical improvement.