Methotrexate persistence and adverse drug reactions in patients with juvenile idiopathic arthritis



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.

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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
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
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3043330