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Methotrexate depresses immunoglobulins in children

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Children treated with methotrexate for joint disease show a fall in immunoglobulins, a preliminary study has found. Now the researchers suggest a prospective study, including other inflammatory markers and measuring functional antibody concentrations, to assess the importance of the observation for this second line treatment.

Researchers at the Alder Hey Children’s Hospital, Liverpool, UK, made the discovery from a retrospective case review of 78 children in the care of the paediatric rheumatologists there over the past two years.

Serum immunoglobulin concentrations fell significantly in the group overall (mean fall in IgG 4.03 g/l, 26%; IgA 0.37 g/l, 21%; and IgM 0.25 g/l, 17%). The results were corroborated for paired samples, which were available for 38 children. Mean fall was larger for methotrexate given subcutaneously than by mouth, and significantly so for IgG. Furthermore, falls in IgG below normal values occurred in six children—all with systemic disease—and all in subclass IgG1. Falls in IgG were not correlated with falls in other inflammatory markers, where data existed for them.

Among the 78 children whose notes were studied, 52 had polyarticular juvenile idiopathic arthritis (JIA), 17 had systemic onset JIA, and nine had other connective tissue diseases. Fifty were receiving low dose (10 mg/m3) methotrexate and 26 medium dose (15–20 mg/m3).

A fall in immunoglobulins with methotrexate treatment has been noted anecdotally by the researchers but has not been studied before.

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