Methotrexate remains an effective treatment for JIA, although nausea is common

What is it about?

What was already known? Methotrexate is the current recommended first-line therapy for children and young people with juvenile idiopathic arthritis (JIA). It is generally considered an effective treatment with a good safety profile. However, it is estimated up to a third of children do not respond, and others report that they get nausea which limits their ability to take this medication. However, the extent to which this occurs in routine practice is not well understood. The aims of this analysis were to (i) calculate how many patients starting methotrexate stopped therapy and why, and (ii) describe the types of side effects, sometimes referred to as adverse drug reactions, patients experienced. What was discovered? This analysis includes 577 children and young people with JIA starting methotrexate therapy between 2010 and 2015 in two UK JIA studies: the Biologics for Children with Rheumatic Diseases (BCRD) study and the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study (BSPAR-ETN). Overall methotrexate was well tolerated. Nearly half of patients (46%) remained on methotrexate after two years of starting this drug with most who stopped doing so because the drug was not effective. One third of patients did experience a side effect; the majority of these were nausea or vomiting-like symptoms (gastrointestinal) as previously suspected. It was difficult to predict which patients would experience nausea but it was more common in older children.

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Photo by Hyttalo Souza on Unsplash

Photo by Hyttalo Souza on Unsplash

Why is it important?

This research supports opinion that methotrexate is an effective and safe first-line DMARD for children and young people with JIA. Most children appeared to tolerate the medication although at least one-in-four did also experience nausea. In most cases, this was not the main reason for stopping therapy and children were more likely to stop because the drug did not work. Understanding why older children may report more nausea needs further investigation as it could relate to dose, although it may be that older children are more likely to report specific symptoms to their parents and doctors. Managing this nausea in clinical practice may allow more children to benefit from methotrexate in future.

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