A64: Patient‐Reported Side Effects with Weekly Injections of Methotrexate in Tertiary Care Rheumatology Clinic

Abstract

Background/Purpose:Methotrexate is frequently used to treat a variety of paediatric rheumatologic conditions. We explored patient‐reported frequency of side effects and coping strategies for weekly injections of subcutaneous methotrexate.Methods:A prospective observational cohort study was conducted from June 2013 through August 2013. All patients with clinic appointments in rheumatology during this period were screened for eligibility. Patients aged 4–17 years who were currently receiving weekly subcutaneous methotrexate injections for at least 4 weeks were invited to participate in the study. A focused interview with the patient and family members, conducted by one interviewer, investigated their experiences with subcutaneous methotrexate. The interview consisted of 18 questions and required approximately 10 minutes to complete.Results:42 patients met inclusion criteria and 41 consented to participate in the study. The mean age was 11.2 years (SD = 3.9 yrs) and 68% of participants were female. Most of these patients were diagnosed with juvenile idiopathic arthritis (73%). Mean duration of therapy with subcutaneous injections of methotrexate was 2.5 years (SD = 2.1 yrs) and the dosing range was 0.3\N1 mg/kg/week (maximum 25 mg/week). Almost all patients (95%) reported excellent adherence to the treatment regimen, missing less than one dose per month. The two most commonly reported side effects were nausea and vomiting (56% and 34% of patients, respectively). Less frequently reported side effects included fatigue (29%), anorexia (24%), headache (15%), and recurrent oral ulcers (10%). Of patients who experienced nausea, 74% used dimenhydrinate while 48% used ondansetron to manage their symptoms. Similarly, many patients who experienced vomiting tried to alleviate their symptoms with dimenhydrinate (64%) or ondansetron (50%). While dimenhydrinate effectively treated nausea in only 42% of patients, most patients reported good efficacy of ondansetron (83%). A similar effect was observed for treatment of vomiting (efficacy of dimenhydrinate 12% versus ondansetron 75%). None of the patients tried ginger to alleviate nausea/vomiting. Except for oral ulcers, clinical side effects resolved within 24 hours in 88% of patients. Of patients who had used oral methotrexate in the past, only 26% felt that the oral form was better tolerated.Conclusion:More than half of the patients reported at least one side effect that could be attributed to methotrexate injections; the most frequent ones were nausea and vomiting. Importantly, most side effects resolved within 24hours and patients reported excellent compliance. In general, patients did not have a preference for oral methotrexate.