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

PLoS One. 2019 Jul 11;14(7):e0219539. doi: 10.1371/journal.pone.0219539. eCollection 2019.

Abstract

Objectives: To analyse the internal consistency of an adaption of the methotrexate intolerance severity score (MISS); and to describe and compare the level of methotrexate intolerance evaluated by the MISS in Danish children with juvenile idiopathic arthritis (JIA) or acute lymphoblastic leukaemia (ALL), treated with low-dose methotrexate (MTX).

Methods: Cross-sectional study of children diagnosed with JIA or ALL, treated with low-dose MTX, aged 9 years or above, and cognitively intact. The patient's parents completed the MISS. MTX intolerance was defined as a total MISS score above 6.

Results: We enrolled 120 children with JIA and 23 children with ALL. The MISS had a good internal consistency in the JIA group. The median MISS score was higher in the JIA group than in the ALL group (JIA: 8; ALL: 1; p<0.0001); and the JIA group had a larger proportion of MTX intolerant children than the ALL group (JIA: 73/120; ALL: 4/23; p<0.001). Within both the JIA group and the ALL group, the MISS total score was not significantly correlated with age, MTX dose or the duration of low-dose MTX treatment.

Conclusion: In the JIA group the level of MTX intolerance was higher and more attributed to anticipatory, associative and behavioural symptoms than in the ALL group. The MISS may help to uncover whether MTX intolerance is present and which aspects are affected in the individual patient, thus guiding intervention. The MISS may also be applicable within leukaemia care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Antirheumatic Agents / administration & dosage*
  • Antirheumatic Agents / adverse effects
  • Arthritis, Juvenile / drug therapy*
  • Arthritis, Juvenile / pathology
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Male
  • Methotrexate / administration & dosage*
  • Methotrexate / adverse effects
  • Parents
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / pathology
  • Treatment Outcome

Substances

  • Antirheumatic Agents
  • Methotrexate

Grants and funding

This work was funded by the Danish Childhood Cancer Foundation (https://boernecancerfonden.dk) to NK; the Danish Rheumatism Association (R128-A2294; R141-A4002) (https://www.gigtforeningen.dk) to NK and the Arvid Nilsson’ Foundation (http://arvidnilssonsfond.dk) to NK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.