Stimmt es eigentlich, dass subkutanes Methotrexat der oralen Gabe hinsichtlich Wirksamkeit und Verträglichkeit bei der Behandlung der JIA überlegen ist?

Zusammenfassung

Methotrexat (MTX) ist das am meisten verschriebene konventionelle Disease-Modifying Antirheumatic Drug (DMARD). In zahlreichen internationalen Leitlinien für die polyartikuläre juvenile idiopathische Arthritis (pJIA) ist MTX als Erstlinientherapie als Basismedikament empfohlen, trotzdem mangelt es an Konsensus-basierten Empfehlungen zur Verabreichungsform. Diese ist nicht standardisiert und abhängig von der Präferenz des behandelnden Rheumatologen [1], [2]. Insgesamt gibt es nur wenige Publikationen zur Evidenz bzgl. der Applikationsweise von MTX bei der JIA. Die Ergebnisse sind sehr variabel und widersprüchlich, wahrscheinlich bedingt durch sehr unterschiedliche Studiendesigns (retrospektive Registeranalysen, prospektive Beobachtung, prospektive Behandlungsstudie) und überwiegend sehr geringe Fallzahlen [3]. In den letzten Jahren wurden einige größere Studien durchgeführt zum Vergleich der Wirksamkeit von oralem zu subkutanem (s. c.) MTX, jedoch ausschließlich bei Patienten mit rheumatoider Arthritis (RA). In einem kürzlich veröffentlichten Update der aktuellen Literatur zeigt sich keine eindeutige Evidenz, dass die s. c.-Gabe der oralen überlegen ist [4].

Abstract

Methotrexate (MTX) is the most commonly prescribed conventional disease-modifying antirheumatic drug (DMARD). Numerous international guidelines for polyarticular juvenile idiopathic arthritis (pJIA) recommend MTX as a first-line therapy and basic medication, yet there is a lack of consensus-based recommendations on the form of administration. This is not standardized and depends on the preference of the treating rheumatologist [1], [2]. Overall, there are only a few publications on the evidence regarding the method of application of MTX in JIA. The results are highly variable and contradictory, probably due to very different study designs (retrospective registry analyses, prospective observation, prospective treatment study) and predominantly very small case numbers [3]. In recent years, several larger studies have been conducted to compare the efficacy of oral and subcutaneous (s. c.) MTX, but only in patients with rheumatoid arthritis (RA). A recently published update of the current literature shows no clear evidence that s. c. administration is superior to oral administration [4].

Schlüsselwörter

DMARD - JIA - Methotrexat - oral vs. subkutan

Keywords

DMARD - JIA - methotrexate - oral vs. subcutaneous

• Literatur

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