For Juvenile Arthritis, Methotrexate Injection Not Superior to Oral Therapy

In a retrospective analysis of safety data, injection of methotrexate (MTX) was not superior to oral therapy in the long-term treatment of patients with juvenile idiopathic arthritis (JIA). The findings suggest that with similar efficacy and tolerability, the more comfortable oral approach may be more suitable for treating patients with pediatric arthritis.

Researchers used data collected by the German Methotrexate Registry since 2005 to identify patients with JIA who were treated with MTX for at least 6 months and who did not receive additional biologic therapies. Study groups received oral MTX or MTX injections in comparable doses.

A clinical response (efficacy) based on the American College of Rheumatology (ACR) pediatric 30 score after 6 months of MTX therapy was found in 72% of patients who received oral therapy and 73% of those who used injections. At least one adverse event was reported in 22% of patients in the oral cohort, compared with 27% in the injection-therapy group. Significantly more patients who received MTX injections discontinued treatment because of adverse events than those who received oral treatment (11% vs 5%).

The researchers concluded that with similar efficacy and tolerability of MTX in the delivery methods, the often unpopular MTX injection probably may be spared without clinical consequences, and they recommended further controlled studies to determine the best application route for treatment with MTX in patients with JIA. The findings were published in Arthritis Care & Research, an ACR journal.