Countermeasures against methotrexate intolerance in juvenile idiopathic arthritis instituted by parents show no effect

Abstract

MTX intolerance was present in many children with JIA and symptoms decreased little in the short term. Various modalities used as countermeasures against nausea by parents showed no discernible effect.

Increased methotrexate intolerance in juvenile idiopathic arthritis compared to acute lymphoblastic leukaemia in children

“…This may contribute to the high number of MTX intolerant children in our JIA group. Especially, when studies have shown that MTX intolerance develops within the first year of low-dose MTX treatment and stays rather stable over time [7,16,18]. However, the duration of low-dose MTX treatment in our JIA group is comparable to the study by Scheuern et al [7] finding a lower proportion of MTX intolerant patients with JIA.…”

“…Especially, when studies have shown that MTX intolerance develops within the first year of low-dose MTX treatment and stays rather stable over time [7,16,18]. However, the duration of low-dose MTX treatment in our JIA group is comparable to the study by Scheuern et al [7] finding a lower proportion of MTX intolerant patients with JIA. Additionally, in our study the median duration of low-dose MTX treatment was the same in the JIA subgroup of MTX tolerant patients as in the JIA subgroup of MTX intolerant patients.…”

“…Gastrointestinal adverse effects, including anticipatory and associative symptoms, are described to be a significant clinical challenge to low-dose MTX treatment in JIA [5–7]. With the increasing survival rates of children with ALL [8–10] the role of adverse effects related to the maintenance treatment has gained higher significance, but there are few studies focusing on low-dose MTX.…”

Contradictory and weak evidence on the effectiveness of anti-emetics for MTX-intolerance in JIA-patients

“…Recently two large studies on anti-emetics for MTX-intolerance in pediatric patients have been published, providing some evidence against the conclusion by Falvey et al [ 4 , 5 ]. Scheuern et al described the results of a prospective, observational study in 196 JIA patients.…”

“…Scheuern et al described the results of a prospective, observational study in 196 JIA patients. They concluded that “various modalities used as countermeasures against nausea (…) showed no discernible effect” [ 4 ]. Dupont-Lucas et al performed an observational study in 102 pediatric IBD patients.…”