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Methotrexate for the Treatment of Pediatric Crohn's Disease: A Systematic Review and Meta-analysis

Ruben J Colman1,2, Rachel C Lawton3, Marla C Dubinsky4

  • 1Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, Illinois.

Inflammatory Bowel Diseases
|April 25, 2018
PubMed

Insights

Methotrexate (MTX) effectively induces clinical remission in over 50% of pediatric Crohn's disease patients. However, long-term maintenance remission rates with MTX are lower, highlighting the need for further research.

Area of Science:

  • Pediatric Gastroenterology
  • Immunomodulatory Therapies
  • Inflammatory Bowel Disease Research

Background:

  • Methotrexate (MTX) is an established immunomodulator for pediatric inflammatory bowel disease (IBD).
  • Existing literature lacks randomized controlled trials (RCTs) on MTX efficacy in pediatric IBD.
  • This study systematically reviews and meta-analyzes the efficacy of MTX in pediatric IBD patients.

Purpose of the Study:

  • To assess the treatment efficacy of methotrexate (MTX) in pediatric inflammatory bowel disease (IBD) patients.
  • To consolidate existing evidence on MTX effectiveness from pediatric literature.
  • To determine clinical remission rates associated with MTX therapy in this population.

Main Methods:

  • A systematic literature search was conducted in MEDLINE and the Cochrane library until March 2016.
  • Included studies focused on pediatric IBD patients (≤18 years) receiving MTX as monotherapy or combination therapy, reporting clinical remission (CR) rates.
  • A random-effects meta-analysis was performed on eligible observational studies (n=886 patients) after quality assessment using the Newcastle-Ottawa Scale.

Main Results:

  • Fourteen observational studies met eligibility criteria; no RCTs were identified.
  • The pooled clinical remission rate for pediatric Crohn's disease patients on MTX monotherapy within 3-6 months was 57.7%.
  • The 12-month maintenance remission rate was 37.1%, with no significant differences noted based on MTX administration type or thiopurine exposure.

Conclusions:

  • Methotrexate (MTX) demonstrates efficacy in inducing clinical remission in over half of pediatric Crohn's disease patients.
  • Long-term maintenance of remission with MTX at 12 months was observed in 37.1% of patients.
  • Prospective, controlled interventional trials are recommended to further evaluate MTX efficacy in specific pediatric IBD subgroups.
Abstract

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