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Methotrexate Treatment in Pediatric Crohn Disease Patients Intolerant or Resistant to Purine Analogues

Authors :
Yoram Bujanover
Batia Weiss
Rivka Shapiro
Arie Levine
Akiva Fradkin
Efrat Broide
Aaron Lerner
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.

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