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Impact of oral versus subcutaneous methotrexate treatment on the quality of life of children with juvenile idiopathic arthritis
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O metotrexato (MTX) continua a ser a terapêutica de eleição na Artrite Idiopática Juvenil (AIJ), podendo ser administrado por via oral ou subcutânea. Não existem diferenças significativas entre as duas vias de administração, contudo, alguns estudos demonstraram uma maior biodisponibilidade e melhores respostas com o uso de MTX subcutâneo, sobretudo quando em doses mais elevadas. No entanto, um maior receio das injeções, entre outros, pode comprometer a qualidade de vida e a adesão à terapêutica. Este projeto visa comparar o impacto do MTX oral versus subcutâneo na qualidade de vida de crianças e adolescentes com AIJ, bem como a efetividade e os efeitos adversos. Com esse propósito realizou-se um estudo observacional de coorte, seguida prospectivamente no Reuma.pt. A qualidade de vida foi avaliada pelo JAMAR e EQ-5DY e a efetividade pela melhoria da atividade da doença e da função. Os efeitos adversos que levaram a alteração de dose, via de administração ou descontinuação foram recolhidos. Um total de 26 crianças e adolescentes com AIJ, 65.4% raparigas, com uma idade média de 11.9, uma mediana de idade de diagnóstico de 2.7 e uma média de duração de doença de 7.5 anos, foram incluídos. Foram analisados 17 cursos terapêuticos com MTX subcutâneo e 29 com oral. As medianas do EQ-5D-Y foram 0.85 e 1 (p=0.864) e as medianas do JAMAR-criança foram 4 e 3.5 (p=818) para a via subcutânea e oral, respetivamente. O MTX subcutâneo foi superior ao oral na redução da dor, e do JADAS e VS aos 6 meses. Contudo, a dose de MTX subcutâneo foi superior. A tolerância foi semelhante entres as duas vias de administração. Nesta coorte, a via de administração do MTX não afetou a qualidade de vida. O MTX foi eficaz e bem tolerado, independentemente da via de administração.
Methotrexate (MTX), administered either orally or subcutaneously, remains the mainstay of Juvenile Idiopathic Arthritis (JIA) treatment because of its effectiveness and acceptable safety profile. No significant differences between the two routes of administration have been reported, but some studies demonstrated a greater bioavailability with subcutaneous route, especially with higher doses. Nevertheless, fear of injections, among other concerns, can compromise the quality of life and medication adherence. This project addresses the impact of orally and subcutaneously administered MTX on the quality of life of children and adolescents with JIA, as well as the effectiveness and side effects with both routes of administration. The database Reuma.pt was used to perform an observational study. The quality of life was measured by JAMAR and EQ-5DY questionnaires, and effectiveness assessed by the improvement in disease activity and function. Side effects that led to change of dose or route of administration or MTX discontinuation were also collected. A total of 26 children and adolescents with JIA, 65.4% females, with a mean age of 11.9, a median age at diagnosis of 2.7 and a mean disease duration of 7.5 years were included. 17 treatment courses with subcutaneous and 29 with oral MTX were analyzed. The median scores of EQ-5D-Y were 0.85 and 1 (p=0.864) and of JAMAR for children were 4 and 3.5 (p=0.818), for subcutaneous and oral routes of administration, respectively. Regarding effectiveness, subcutaneous MTX was superior to oral MTX, in terms of JADAS and ESR reduction at 6 months and reduction of pain. However, the dosage of subcutaneous MTX was significantly higher. Both subcutaneous and oral MTX were well tolerated. In this cohort, the route of administration of MTX did not affect quality of life. MTX was effective and well tolerated regardless of the route of administration.
Methotrexate (MTX), administered either orally or subcutaneously, remains the mainstay of Juvenile Idiopathic Arthritis (JIA) treatment because of its effectiveness and acceptable safety profile. No significant differences between the two routes of administration have been reported, but some studies demonstrated a greater bioavailability with subcutaneous route, especially with higher doses. Nevertheless, fear of injections, among other concerns, can compromise the quality of life and medication adherence. This project addresses the impact of orally and subcutaneously administered MTX on the quality of life of children and adolescents with JIA, as well as the effectiveness and side effects with both routes of administration. The database Reuma.pt was used to perform an observational study. The quality of life was measured by JAMAR and EQ-5DY questionnaires, and effectiveness assessed by the improvement in disease activity and function. Side effects that led to change of dose or route of administration or MTX discontinuation were also collected. A total of 26 children and adolescents with JIA, 65.4% females, with a mean age of 11.9, a median age at diagnosis of 2.7 and a mean disease duration of 7.5 years were included. 17 treatment courses with subcutaneous and 29 with oral MTX were analyzed. The median scores of EQ-5D-Y were 0.85 and 1 (p=0.864) and of JAMAR for children were 4 and 3.5 (p=0.818), for subcutaneous and oral routes of administration, respectively. Regarding effectiveness, subcutaneous MTX was superior to oral MTX, in terms of JADAS and ESR reduction at 6 months and reduction of pain. However, the dosage of subcutaneous MTX was significantly higher. Both subcutaneous and oral MTX were well tolerated. In this cohort, the route of administration of MTX did not affect quality of life. MTX was effective and well tolerated regardless of the route of administration.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Artrite idiopática juvenil Metotrexato Qualidade de vida Efetividade Efeitos adversos Reumatologia