Background/Purpose: Methotrexate (MTX) is effective and steroid-sparing for pediatric non-infectious anterior uveitis, but whether subcutaneous (SC) achieves control faster than oral (PO) remains unclear. High-dose regimens have been linked to faster remission, though dose–route confounding limits inference. We sought to compare high-dose PO vs SC MTX.

Methods: Single-center retrospective cohort (2007–2024) of children < 18 years with active non-infectious anterior uveitis at MTX initiation. Active uveitis was defined as anterior chamber cells >0.5+, topical steroids >2 drops/day, and/or on systemic steroids. MTX episodes began with initiation or route switch; >180-day washouts separated opposite routes. Doses were aligned using PO-equivalence (1 mg PO = 0.65 mg SC). High dose was >0.5 mg/kg if < 25 kg or >12.5 mg if ≥25 kg. The primary outcome was time to sustained control, defined as two consecutive visits ≤60 days apart with inactive disease. Survival analysis was used to analyze time to sustained control.

Results: Fifty-seven high-dose episodes (52 unique patients) were analyzed: 17 PO and 40 SC. Mean age at start was 7.9 ± 4.0 years (PO 8.0 ± 4.2; SC 7.9 ± 4.0). Kaplan–Meier curves overlapped through 52 weeks; numbers at risk at weeks 0/13/26/39/52 were 17/16/10/5/5 (PO) and 40/38/32/23/20 (SC). In a patient-clustered Cox model, SC vs PO had a hazard ratio of 0.78 (95% CI, 0.34–1.77; p=0.55).

Conclusion: In pediatric anterior uveitis treated with high-dose MTX, SC and PO achieved similar time to sustained control. Clinicians may consider prioritizing tolerance, adherence, and access when choosing route.

SC vs PO MTX for Anterior Uveitis: Kaplan–Meier Curve of Time to Sustained Control

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/oral-vs-subcutaneous-methotrexate-at-high-dose-for-pediatric-anterior-uveitis/