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Methotrexat bei der Therapie der juvenilen idiopathischen Arthritis

Methotrexate in the therapy of juvenile idiopathic arthritis

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Zusammenfassung

Die Behandlung mit niedrig dosiertem Methotrexat (MTX) ist ein wichtiger Bestandteil der Therapie der juvenilen idiopathischen Arthritis (JIA). Anhand placebokontrollierter Studien konnte belegt werden, dass MTX ein sicheres und effektives Medikament ist, das von Kindern und Jugendlichen mit JIA meist gut vertragen wird. Die übliche Dosierung bei der Behandlung der JIA liegt bei 10–15 mg/m2 Körperoberfläche/Woche. Dabei sollte als kindgerechte Applikation die orale Gabe bevorzugt werden. An unerwünschten Wirkungen werden vor allem gastrointestinale Beschwerden wie Übelkeit und Erbrechen sowie Transaminasenerhöhungen beobachtet, bei denen sich die Gabe von Folsäure zur Therapie und Prophylaxe etabliert hat.

Insbesondere für die Entscheidung hinsichtlich Therapiedauer und Beendigung einer MTX-Therapie sowie der Kombinationstherapie mit anderen Basistherapeutika und Biologika existieren bisher keine einheitlichen Behandlungsregime. Diese offenen Fragen sind daher Gegenstand aktueller Studien, bei denen u. a. der Anwendung von Biomarkern eine zunehmend große Bedeutung zukommt.

Abstract

Treatment with low-dose methotrexate (MTX) is an important element in the therapy of juvenile idiopathic arthritis (JIA). It could be demonstrated in placebo-controlled trials that MTX is a safe and effective drug which is generally well tolerated by children and adolescents. MTX is usually used at a dose of 10–15 mg/m2/week, whereby oral administration is preferred for children. Side effects occur mainly in the form of gastro-intestinal discomfort such as nausea and vomiting or raised transaminases, which can be effectively treated with folic-acid supplementation.

There are no general recommendations to date regarding in particular duration and discontinuation of MTX treatment or combination treatment with other disease-modifying antirheumatic drugs or biologics. These unresolved questions are the subject of current trials in which biomarkers have an increasingly important role.

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  1. Institut für Immunologie, Universitätsklinikum Münster, Röntgenstr. 21, 48149, Münster, Deutschland

    D. Holzinger

  2. Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Münster, Münster, Deutschland

    D. Holzinger, M. Frosch & D. Föll

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Holzinger, D., Frosch, M. & Föll, D. Methotrexat bei der Therapie der juvenilen idiopathischen Arthritis. Z. Rheumatol. 69, 496–504 (2010). https://doi.org/10.1007/s00393-010-0633-1

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