Alternative immunosuppressants for younger children to methotrexate

[Bollywoodmummy]

Hi everyone.

My 8 year old daughter was diagnosed with SLE, myositis and idiopathic arthritis in OCT 2020. I also have SLE but was diagnosed when I was around 16.

She was initially given IV prednisolone, hydroxychloroquine, folic acid, lanzoprazole as main treatments. Sent home with oral prednisolone and 2 weeks later methotrexate oral was initiated and then 4 weeks later switched to subcut.

Her ALT's have always been deranged but in the last few weeks they have started to peak. The consultants have been closely monitoring these levels but last week they phoned and said they want to hault the methotrexate for 2 weeks to see if her ALTs improve to determine if it's her SLE or lupus causing this.

She was on 15mg of subcutaneous methotrexate. I was just wondering if it turns out to be that the methotrexate isn't the best option for her. I know it's gold standard and best treatment, but we are all different! But I was just wondering if anyone else has personally or a loved one/ someone they know experienced the same? Especially with her being 8 years old. What was the next option with regards to immunosuppression treatment and was it tolerated better????

Any advice/ help would be very much appreciated.

Thank you once again

Mum

[Paul_Howard Partner LUPUS UK]

Hi Bollywoodmummy ,

The choice of immunosuppressant therapy varies between patients based on their symptoms. In many cases, if methotrexate isn't having the desired effect then I think mycophenolate mofetil would often be the next treatment they would try. Neither is necessarily 'better' or 'tolerated better' than the other - unfortunately it is often a case of trial and error in treating lupus.