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This is the first ever study depicting the expanse of Methotrexate (MTX) adherence in juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM) paediatric patients.
This is the first
ever study depicting the expanse of Methotrexate (MTX) adherence in juvenile
idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM) paediatric
patients. It has been efficiently estimated on the basis of Dried blood spot
measurement of Individual methotrexate polyglutamates.
This is the first
ever study depicting the expanse of Methotrexate (MTX) adherence in juvenile
idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM) paediatric
patients. It has been efficiently estimated on the basis of Dried blood spot
measurement of Individual methotrexate polyglutamates.
Data were collected prospectively from a cohort of 48
children (median age 11.5 years) who received oral or subcutaneous (SC) MTX
therapy for JIA or JDM. Dried blood spot samples were obtained from children by
finger pick at the clinic or via self- or parent-led sampling at home, and they
were analysed to determine the variability in MTXPG concentrations and assess
adherence to MTX therapy.
Wide fluctuations in MTXPG total concentrations
(>2.0-fold variations) were found in 17 patients receiving stable weekly
doses of MTX, which is indicative of nonadherence or partial adherence to MTX
therapy. Age (P = 0.026) and route of administration (P = 0.005) were the most
important predictors of nonadherence to MTX treatment. In addition, the study
showed that MTX dose and route of administration were significantly associated
with variations in the distribution of MTXPG subtypes. Higher doses and SC
administration of MTX produced higher levels of total MTXPGs and selective
accumulation of longer-chain MTXPGs (P < 0.001 and P < 0.0001,
respectively).
Nonadherence to MTX therapy is a significant problem in
children with JIA and JDM. The present study suggests that patients with
inadequate adherence and/or intolerance to oral MTX may benefit from SC administration
of the drug. The clinical utility of MTXPG levels to monitor and optimise
adherence to MTX in children has been demonstrated.
Arthritis research and therapy
Methotrexate polyglutamates as a potential marker of adherence to long-term therapy in children with juvenile idiopathic arthritis and juvenile dermatomyositis: an observational, cross-sectional study
Ahmed F. Hawwa et al.
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