Prefilled pen may be a better way to deliver methotrexate to children with JIA

When methotrexate (MTX) is administered to patients with juvenile idiopathic arthritis (JIA) using a prefilled pen, the procedure is associated with less pain and fewer side effects than when a conventional prefilled syringe is used, according to a study conducted at a pediatric rheumatology center in Poland.

The 23 patients with JIA, who ranged from 2 to 18 years of age (mean age, 11.7 years) were receiving subcutaneous MTX therapy using a prefilled syringe at the start of the study. After completing a questionnaire evaluating their experience with this device, they began a 1-month period of using the prefilled pen and then completed the same questionnaire to document their experience with the new delivery system. Participants also indicated their overall preference for the pen or syringe. Caregivers completed these questionnaires when they, not the patients themselves, administered the MTX.

Almost 83% of patients or caregivers preferred the prefilled pen to the syringe for administering MTX, citing it as easier to use despite having considerably more experience with the syringe. Moreover, injection with the prefilled pen was considered less painful than with the prefilled syringe. Finally, side effects of MTX were less pronounced after treatment with the prefilled pen, particularly with regard to nausea, vomiting, and abdominal pain (Roszkiewicz, J, et al. Pediatr Rheumatol. 2020; Epub ahead of print).

Thoughts from Dr. Farber

I am in favor of anything that reduces pain safely. In the near future, more children will be receiving injections of biologics for conditions such as Crohn’s disease, lupus, and asthma. We will see if the pen proves mightier than the syringe.