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Therapeutic role of methotrexate in pediatric Crohn's disease
Zlatko Djurić1, Ljiljana Šaranac, Ivana Budić
1Division of Gastroenterology, Children's Hospital, Faculty of Medicine, University of Niš, Niš, Serbia. zldjuric@yahoo.com.
Insights
Methotrexate (MTX) shows promise for pediatric Crohn's disease (CD) patients, offering a safer alternative to thiopurines. Further research is needed to confirm its effectiveness as a first-line treatment.
Area of Science:
- Pediatric Gastroenterology
- Immunomodulatory Therapy
- Inflammatory Bowel Disease Research
Background:
- Crohn's disease (CD) management in children focuses on achieving remission and supporting normal growth.
- Immunomodulators like thiopurines and methotrexate (MTX) are used for maintaining remission.
- Concerns regarding hepatosplenic T-cell lymphoma with thiopurines have increased interest in MTX for pediatric CD.
Purpose of the Study:
- To review the existing literature on the therapeutic use of methotrexate (MTX) in children with Crohn's disease (CD).
- To evaluate MTX's efficacy as a second-line immunomodulator in pediatric CD patients.
Main Methods:
- Literature review summarizing studies on MTX treatment in pediatric CD.
- Analysis of clinical remission rates in children treated with MTX.
Main Results:
- Methotrexate (MTX) is frequently used as a second-line immunomodulator for pediatric Crohn's disease (CD).
- One-year clinical remission rates ranged from 25-69% in children with CD when thiopurines were excluded.
- Emerging data suggest MTX may be effective for mucosal healing and as a first-line agent in pediatric CD.
Conclusions:
- Methotrexate (MTX) demonstrates promising therapeutic potential for children with Crohn's disease (CD).
- Current evidence supports MTX's role, particularly as a second-line therapy, with encouraging remission rates.
- Additional large-scale studies are required to establish definitive conclusions regarding MTX's efficacy, especially as a first-line treatment and for mucosal healing.
Abstract:
The main role of therapy in Crohn's disease (CD) is to achieve long-term clinical remission, and to allow for normal growth and development of children. The immunomodulatory drugs used for the maintenance of remission in CD include thiopurines (azathioprine and 6-mercaptopurine) and methotrexate (MTX). Development of hepatosplenic T-cell lymphoma in some patients with inflammatory bowel disease, treated with thiopurines only or in combination with anti-tumor necrosis factor agents, resulted in a growing interest in the therapeutic application of MTX in children suffering from CD. This review summarizes the literature on the therapeutic role of MTX in children with CD. MTX is often administered as a second-line immunomodulator, and 1-year clinical remission was reported in 25-69% of children with CD after excluding for the use of thiopurines. Initial data on MTX effectiveness in mucosal healing, and as a first-line immunomodulator in pediatric patients with CD, are promising. A definite conclusion, however, may only be made on the basis of additional research with a larger number of subjects.