engleski

Efficacy of metothrexate in the treatment of pediatric Crohn's disease – single center report

Objectives and Study: Limited controlled clinical trial data in adults suggest that methotrexate (MTX) is effective for induction and maintainance of remission in Crohn’s disease (CD). The appropriate place of MTX therapy in pediatric population is still not well established. MTX is usually used as a second line therapy in patients who do not respond to azathioprine/ 6-mercaptopurine. The aim of our study was to estimate the efficacy and safety of MTX in the maintenance of remission of CD in our patients. Methods: Data of all children with CD diagnosed and treated from January 2004 to December 2010 (n¼72) were retrospectively analyzed. In this report, only children with the disease which was steroid dependent and azathioprine resistant and who were therefore treated with MTX were included. MTX was administrated intramuscularly at a weekly dose of 15mg/m2. We reviewed case records for medications used, number of relapses prior to and after MTX introduction, duration of remission prior to and after MTX introduction, and for complications of treatment. Remission was defined as a state with no symptoms of the disease and defined as PCDAI score <10. Results: During the study period a total number of 24 patients (75% male and 25% female ; median age at diagnosis 13.3 years, mean 12.6, range 1.6–17 years) were treated with MTX. Before MTX, all patients received azathioprine and 6 patients underwent surgery. Median duration of the disease before introduction of MTX was 15 months (mean 21.9 months, range 4.6 months to 6 years). Nineteen patients were followed up more than 6 months after introduction of MTX (median 2.1 years, mean 2.2 years, range 0.5 to 3.9 years). Before MTX treatment all patients had moderate to severe disease (PCDAI median 40, mean 43.9, range 30–60). After 6 months of therapy 15 (78.9%) patients were in remission. Eight patients (42%) had relapse under MTX during follow up, median time of remission duration was 5 months (mean 7.5, range 3–24 months). In one patient remission was not achieved. Ten patients (53%) were in stable remission under the MTX treatment (median follow up time 18 months, mean 10 months, range 6–36 months). Altogether patients were in significantly longer remission under MTX treatment than before (P¼0.014). Median time for remission achievement was 2.5 months. Concerning adverse effects, two patients had elevated liver enzymes and one patient had nausea which improved with decreasing MTX dose. Conclusion: Although data in our study are retrospectively collected and are limited with small number of patients, we can conclude that MTX is well tolerated and effective treatment in remission maintenance in children with CD whose disease is not responsive to usually used first-line maintenance therapy, azathioprine.

IBD; MTX

doi: 10.1097/MPG.0b013e318224e326