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Methotrexate Treatment in Pediatric Crohn Disease Patients Intolerant or Resistant to Purine Analogues
- Source :
- Journal of Pediatric Gastroenterology & Nutrition. 48:526-530
- Publication Year :
- 2009
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2009.
-
Abstract
- Background Immunomodulatory drugs play a major role in maintaining remission and steroid sparing in children with Crohn disease. Although thiopurine agents are commonly used, unresponsiveness or intolerance to these drugs is common. The efficacy of methotrexate in maintenance of remission has been shown in adult Crohn disease; however, pediatric data are limited. Our goal was to evaluate the efficacy and safety of methotrexate in induction and maintenance of clinical remission in children with active Crohn disease who failed thiopurine treatment. Patients and methods In a retrospective multicenter study, efficacy of methotrexate in inducing and maintaining remission or response was assessed by Harvey-Bradshaw activity index, paediatric Crohn disease activity index and steroid use, in 25 children with Crohn disease, refractory or intolerant to thiopurine analogues. Results Crohn disease was diagnosed at a mean age of 11.1 +/- 3.1 years and methotrexate was initiated at age 14.5 +/- 3.1 years. The median methotrexate dose was 12.5 mg/m2. Remission was achieved in 16 patients (64%), and response in 6 patients (24%). Out of 18 patients treated for longer than 6 months, 83% were in remission or response after 12 months of treatment. The mean duration of remission and response was 10.8 +/- 8.8 months. Steroid withdrawal was possible in 12/16 patients (75%) receiving steroids at methotrexate introduction. Adverse effects were observed in 6 patients (24%) including nausea and vomiting in 3, elevation of liver enzymes in 2 and pancreatitis in 1 patient. Conclusions Methotrexate is beneficial in maintaining remission and steroid-sparing treatment in children with Crohn disease following failure of thiopurine therapy.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
Nausea
medicine.drug_class
Injections, Subcutaneous
Drug Resistance
Administration, Oral
Azathioprine
Antimetabolite
Gastroenterology
chemistry.chemical_compound
Crohn Disease
Internal medicine
Humans
Medicine
Child
Adverse effect
Retrospective Studies
Thiopurine methyltransferase
biology
Mercaptopurine
business.industry
Remission Induction
Drug Tolerance
Surgery
Methotrexate
chemistry
Pediatrics, Perinatology and Child Health
Antifolate
Vomiting
biology.protein
Female
Steroids
medicine.symptom
business
Immunosuppressive Agents
medicine.drug
Subjects
Details
- ISSN :
- 02772116
- Volume :
- 48
- Database :
- OpenAIRE
- Journal :
- Journal of Pediatric Gastroenterology & Nutrition
- Accession number :
- edsair.doi.dedup.....fa5298f56a58110f1f0836f8a97bf079
- Full Text :
- https://doi.org/10.1097/mpg.0b013e318196df3e