Related Experiment Video
Updated: May 29, 2026
Mechanistic Insight into the Development of TNBS-Mediated Intestinal Fibrosis and Evaluating the Inhibitory Effects of Rapamycin
Published on: September 12, 2019
Concomitant therapy with methotrexate and anti-TNF-α in pediatric patients with refractory crohn's colitis: a case
Imad Absah1, William A Faubion
1Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA. absah.imad@mayo.edu
Insights
Combining methotrexate with anti-tumor necrosis factor alpha (TNF-α) therapy shows promise for pediatric Crohn
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Pharmacological Interventions
Background:
- Pediatric Crohn's colitis refractory to anti-tumor necrosis factor alpha (TNF-α) therapy presents a clinical challenge.
- Tertiary care centers frequently encounter these difficult-to-treat cases.
Purpose of the Study:
- To evaluate the efficacy and safety of combining methotrexate with anti-TNF-α therapy in pediatric patients with refractory Crohn's colitis.
- To assess clinical remission rates and adverse events in this patient cohort.
Main Methods:
- Retrospective review of 14 pediatric patients with Crohn's disease (CD) failing anti-TNF-α therapy.
- Patients received concomitant methotrexate and anti-TNF-α treatment between 2007 and 2010.
- Clinical remission defined by short pediatric Crohn's Disease Activity Index (PCDAI).
Main Results:
- 50% of patients achieved clinical remission within an average of 6 weeks.
- Adverse events were generally mild (nausea, headache), with only one discontinuation.
- Clostridium difficile infection complicated therapy in 28.6% of patients.
Conclusions:
- Concomitant methotrexate and anti-TNF-α therapy is a viable and promising treatment option for pediatric refractory Crohn's colitis.
- This combination strategy offers a potential benefit for children with severe, treatment-resistant disease.
Background:
Crohn's colitis refractory to anti-tumor necrosis factor alpha (TNF-α) therapy is commonly seen in tertiary care centers for pediatric inflammatory bowel disease (IBD). We report our experience in managing pediatric refractory Crohn's colitis with concomitant use of methotrexate and anti-TNF-α therapy.
Methods:
We reviewed records from 2007 to 2010 at the Mayo Clinic pediatric IBD center. We included all patients with Crohn's disease (CD) failing anti-TNF-α therapy who then received concomitant methotrexate. The primary endpoint was clinical remission, defined as inactive disease in accordance with the short pediatric CD activity index (PCDAI). The secondary endpoint was last day of follow-up.
Results:
Fourteen patients with CD received concomitant methotrexate and anti-TNF-α treatment (age, mean [range], 15.7 [6-20] years; standard deviation [SD], 3.4 years). Mean age at diagnosis was 12.5 years (range, 3-17 years; SD, 3.83 years). The male-to-female ratio was 10:4. All patients had moderate to severe disease activity using the short PCDAI and had predominately Crohn's colitis. Twelve patients were previously treated with thiopurines (85.7%). Seven patients (50%) were in clinical remission within an average of 6 weeks postmethotrexate induction. Five patients (35.7%) experienced adverse events including nausea and headache, yet only one discontinued therapy due to adverse events. Infection with Clostridium difficile was common, complicating therapy in four patients (28.6%).
Conclusions:
Concomitant use of methotrexate and anti-TNF-α therapy is a promising option for children with refractory Crohn's colitis.
Related Concept Videos
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:29Therapeutic Drug Monitoring: Affecting Factors
01:25Inflammatory Bowel Disease III: Crohn's Disease