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Real-world data on MTX tolerance with regimens used in children versus adults

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Abstract

Objective

Methotrexate (MTX) is one of the most commonly used disease-modifying anti-rheumatic drugs which can cause gastrointestinal side effects. MTX intolerance is defined as gastrointestinal and behavioral symptoms occurring before and after MTX administration. This study aims to evaluate and compare the frequency of methotrexate intolerance in adult and pediatric patients.

Methods

Patients with a rheumatic disease who used oral or parenteral methotrexate for at least 3 months were included in the study. Methotrexate intolerance was assessed using the Methotrexate Intolerance Severity Score (MISS) questionnaire and visual analog scale (VAS). In the pediatric patient group, the MISS questionnaire and VAS assessment were applied to both patients and families.

Results

A total of 200 patients, 100 of whom were children, were enrolled in the study. The mean age for children and adults were 11.9 (± 3.7) and 52.0 (± 10.9). The prevalence of MTX intolerance was higher in the pediatric group, 64.0 and 10.0% (p < 0.001), respectively. Compared with oral administration, the patients receiving parenteral MTX had a higher proportion of MTX intolerance (p < 0.001). Younger age was the independent risk factor for MTX intolerance. There was a strong correlation between MISS and VAS scores between the evaluations of the patient and the family (p < 0.01, r = 0.95/p < 0.01, r = 0.94).

Conclusion

Methotrexate intolerance was higher in childhood. All patients using MTX should be monitored and questioned for signs of intolerance.

Key Points

• MTX intolerance poses a risk for the successful maintenance of anti-rheumatic therapy.

• All patients using MTX should be monitored and questioned for signs of intolerance.

• Younger age is an independent risk factor for MTX intolerance.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Author information

Authors and Affiliations

  1. Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Sihhiye campus, 06100, Ankara, Turkey

    Ummusen Kaya Akca, Erdal Sag, Erdal Atalay, Muserref Kasap Cuceoglu, Ozge Basaran, Seza Ozen & Yelda Bilginer

  2. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Bayram Farisogullari, Gozde Kubra Yardimci & Levent Kilic

Authors
  1. Ummusen Kaya Akca
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  2. Bayram Farisogullari
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  3. Gozde Kubra Yardimci
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  4. Erdal Sag
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  5. Erdal Atalay
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  6. Muserref Kasap Cuceoglu
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  9. Seza Ozen
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Contributions

Dr. Kaya Akca, Dr. Basaran, Dr. Kilic, Dr. Ozen, and Dr. Bilginer conceptualized and designed the study, collected data, drafted the initial manuscript, and reviewed and revised the manuscript.

Dr. Kaya Akca, Dr. Farisogullari, Dr. Yardimci, Dr. Sag, Dr. Atalay, Dr. Kasap Cuceoglu, Dr. Basaran, Dr. Kilic, Dr. Ozen, Katlan, and Dr. Bilginer carried out the initial analyses, collected data, and reviewed and revised the manuscript.

Dr. Ozen, Dr. Bilginer, Dr. Basaran, and Dr. Kilic critically reviewed the manuscript for important intellectual content.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Yelda Bilginer.

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Kaya Akca, U., Farisogullari, B., Yardimci, G.K. et al. Real-world data on MTX tolerance with regimens used in children versus adults. Clin Rheumatol 40, 5095–5102 (2021). https://doi.org/10.1007/s10067-021-05802-8

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  • DOI: https://doi.org/10.1007/s10067-021-05802-8

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