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Abstract Number: 48

Methotrexate use and route of administration in JIA: Results from the Childhood Arthritis & Rheumatology Research Alliance Registry

Sarah Ringold1, Fenglong Xie2, Yukiko Kimura3, Laura E. Schanberg4, Timothy Beukelman5 and and the CARRA Registry Investigators, 1Seattle Children's Hospital, Seattle, WA, 2Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 3Hackensack University Medical Center, Hackensack, NJ, 4Pediatrics, Duke Medical Center, Durham, NC, 5Pediatric Rheumatology, University of Alabama at Birmingham, Birmingham, AL

Meeting: 2017 Pediatric Rheumatology Symposium

Keywords: juvenile idiopathic arthritis (JIA), methotrexate (MTX) and registries

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Session Information

Date: Thursday, May 18, 2017

Session Title: Clinical and Therapeutic Poster Session

Session Type: Abstract Submissions

Session Time: 5:30PM-7:00PM

Background/Purpose: The Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry began enrolling children with juvenile idiopathic arthritis (JIA) in July 2015. The large number of children with prevalent JIA in the Registry provides a unique opportunity to study longitudinal medication use in clinical practice, including the use of methotrexate (MTX).

Methods: Participants were enrolled at 55 centers in the US and Canada. Children with the following characteristics were eligible for enrollment in the Registry: 1) new diagnosis JIA; 2) systemic JIA; 3) history of ≥ 5 joints involved during disease course; 4) children newly starting or re-starting MTX or biologic. Data were obtained from Registry medication logs that contain the patient’s complete medication use history, including start and stop dates. Children were included in this analysis if they were ≥ 12 months since JIA diagnosis and treated with MTX.  Patient date of diagnosis and medication start and stop dates were imputed if month or day were missing. Median and IQR for time to initiation of biologic therapy was calculated for those patients who started a biologic >= 60 days after MTX, in order to exclude those who were intended to have initial therapy with combination biologic and MTX therapy.

Results: Nine hundred and three children were included in the analysis (Table 1). Median time between diagnosis and initiation of MTX was 61 days (IQR: 0-461) and was similar for those initially started on oral (PO) and those initially started on subcutaneous (SQ).  Forty-four percent of children received their initial MTX as PO. Children with extended oligoarthritis had the lowest proportion of initial PO MTX (26%) and children with polyarticular JIA RF+ had the highest percentage (56%).  Among children started on initial PO MTX, 31% switched to SQ during their follow-up. Among children started on initial SQ MTX, 25% switched to PO. Median time to initial biologic therapy among those receiving initial PO MTX was 304 days (IQR: 142-731) and 250 days (IQR: 122-813) for those receiving initial SQ MTX.

Conclusion: Among this large cohort of children with JIA, route of initial MTX therapy was relatively evenly divided between SQ and PO and switching between routes was common. Patients started on SQ MTX had a somewhat shorter time to initiation of biologic therapy. Additional analyses will evaluate the associations between initial route of MTX, patient characteristics, and clinical outcomes.

Table 1. Methotrexate use and route of administration

Characteristic

Any methotrexate

Initial PO

methotrexate

 

Initial SQ

methotrexate

All eligible patients – n (%)

903

400 (44)

503 (56)

ILAR category – n (%)

 

 

 

Oligoarthritis – persistent

121

43 (36)

78 (64)

Oligoarthritis – extended

45

12 (26)

33 (74)

Polyarthritis, RF-

457

208 (46)

249 (54)

Polyarthritis, RF+

88

49 (56)

39 (44)

Psoriatic arthritis

41

19 (46)

22 (54)

Enthesitis related arthritis

45

21 (47)

24 (53)

Systemic arthritis

91

40 (44)

51 (56)

Undifferentiated arthritis

13

8 (62)

5 (38)

Switched MTX Route – n (%)

250 (28)

125 (31)

125 (25)

Elapsed time to start MTX – days; median (IQR)

61 (0-461)

63 (0-435)

59 (0-474)

Elasped time to switch MTX route  – days; median (IQR)

456 (169-1038)

273 (118-761)

666 (349-1312)

Elapsed time to start biologic if not initial combination therapy  – days; median (IQR)

271 (133-745)

304 (142-731)

250 (122-813)

PO: oral; SQ: subcutaneous


Disclosure: S. Ringold, None; F. Xie, None; Y. Kimura, 2,9; L. E. Schanberg, 9,9,9; T. Beukelman, None.

To cite this abstract in AMA style:

Ringold S, Xie F, Kimura Y, Schanberg LE, Beukelman T. Methotrexate use and route of administration in JIA: Results from the Childhood Arthritis & Rheumatology Research Alliance Registry [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 4). https://acrabstracts.org/abstract/methotrexate-use-and-route-of-administration-in-jia-results-from-the-childhood-arthritis-rheumatology-research-alliance-registry/. Accessed January 31, 2023.
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