These abstracts from ACR 2014 focus on medication issues for children with JIA. The first abstract deals the reality that children taking methotrexate often develop anticipatory or associative nausea as a conditioned response. And beside every kid with nausea is a parent trying every trick in the book to help get that methotrexate down. But, does hiding the methotrexate in chocolate pudding actually work? The second abstract addresses questions about the safety of biologics in children. Methotrexate has been around for decades so a lot is known about its long-term safety profile. But when kids with arthritis don’t improve on methotrexate, the next step may be to try the newer biologics, with which we have more limited experience. Does starting a biologic put your child at risk?
Countermeasures Against Methotrexate Intolerance in JIA Instituted by Parents Show No Effect. Scheuern et al. German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany.
In this study, the authors investigated the course of methotrexate intolerance in pediatric patients over 6 months old, as well as the effect of countermeasures by parents on the severity of methotrexate intolerance. The poster includes the data from more subjects than the abstract. From the poster data, 90 kids with JIA (median age 11.7 years old) who were taking methotrexate for at least 3 months and who had associated nausea (as measured by the Methotrexate Intolerance Severity Score of > 6) were monitored over a 6 month period. 40 countermeasures were attempted and grouped into categories: antiemetic drugs, covert dosing, taste masking and complementary medicine. At the initiation of the study, median MISS score was 11 and after 6 months was 8 (p=0.451, so no statistically significant difference). There was no difference between patient receiving parental countermeasures (n=68) and patients not receiving countermeasures (n=22). The authors concluded that if patients with JIA show MTX intolerance, symptoms will not decrease over 6 months. Various modalities used by parents of JIA patients as countermeasures against MTX intolerance symptoms show no discernible effect.
Drug Safety in Treatment of Juvenile Idiopathic Arthritis: Biologic Therapy Compared to Methotrexate. Gerd Horneff et al. Asklepios Klinik Sankt Augustin, Germany.
This prospective observational study followed patients with JIA in the German JIA biologic registry, BiKer. Patients were grouped by biologic – 1925 patients on etanercept, 498 patients on adalimumab and 104 patients on tocilizumab. Controls were 1517 patients on methotrexate who were biologic-naïve. The patients were monitored for adverse events as seen in the chart below:
The authors conclude that the data from the ongoing-BiKeR-registry showed a higher incidence for several adverse events including severe infections, autoimmunity, uveitis, anaphylaxis and MAS while the total rate is surprisingly low. In general, JIA patients tolerated biologic treatment very well. Differences between the cohorts are at least in part biased by differences in JIA category distribution and pre-existing uveitis risk.