Kearsley-Fleet, Lianne, Gonzalez, Laura Vicente, Steinke, Douglas, Davies, Rebecca, De Cock, Diederik, Baildam, Eileen, Beresford, Michael W ORCID: 0000-0002-5400-9911, Foster, Helen E, Southwood, Taunton R, Thomson, Wendy et al (show 1 more authors)
(2019)
Methotrexate persistence and adverse drug reactions in patients with juvenile idiopathic arthritis.
RHEUMATOLOGY, 58 (8).
pp. 1453-1458.
Abstract
<h4>Objectives</h4>This analysis aims to calculate MTX monotherapy persistence and describe the occurrence of and factors associated with the occurrence of adverse drug reactions (ADRs) with MTX.<h4>Methods</h4>Patients with JIA starting MTX monotherapy from two UK studies were included. Patient characteristics, treatment details and ADR occurrence were collected at treatment start, 6 months, 1 year and annually. The following groups of ADRs were included: gastrointestinal, elevated liver enzymes, leukopenia, drug hypersensitivity, rash, needle phobia and any events leading to permanent MTX discontinuation. Treatment exposure was calculated from MTX start until MTX monotherapy cessation, last follow-up or 31 December 2017 (cut-off), whichever came first. Survival analysis assessed the time on MTX monotherapy and the time to the first ADR on MTX monotherapy within 2 years. Multivariable logistic regression assessed characteristics associated with any ADR and gastrointestinal ADRs.<h4>Results</h4>A total of 577 patients started MTX. At 2 years, 310 (54%) were no longer on MTX monotherapy. Reasons included ineffectiveness (60%; 161/185 started a biologic), adverse event (25%), remission (8%) and patient/family decision (3%). Over this time, 212 (37%) patients experienced one or more ADR; commonly gastrointestinal (68%) or elevated liver enzymes (26%). Lower physician global assessment and older age predicted any ADR and gastrointestinal ADR, respectively. Patients with polyarticular RF and JIA had reduced odds of both any ADR and a gastrointestinal ADR.<h4>Conclusion</h4>After 2 years, more than half the patients were no longer on MTX monotherapy, while more than one-third experienced one or more ADR, most commonly gastrointestinal. Research focusing on identifying which children will respond and/or experience ADRs is crucial to inform treatment decisions and management planning.
Item Type: | Article |
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Uncontrolled Keywords: | DMARDs, epidemiology, juvenile idiopathic arthritis, outcome measures, statistics |
Depositing User: | Symplectic Admin |
Date Deposited: | 28 May 2019 10:44 |
Last Modified: | 07 Feb 2024 21:10 |
DOI: | 10.1093/rheumatology/kez048 |
Open Access URL: | https://doi.org/10.1093/rheumatology/kez048 |
Related URLs: | |
URI: | https://livrepository.liverpool.ac.uk/id/eprint/3043330 |