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Methotrexate in patients with Crohn's disease after 6-mercaptopurine
D R Mack1, R Young, S S Kaufman
1Department of Pediatrics, University of Nebraska Medical Center, Omaha 68198-5160, USA.
Insights
Subcutaneous methotrexate effectively treated pediatric Crohn
Area of Science:
- Pediatric Gastroenterology
- Immunomodulatory Therapy
- Crohn's Disease Research
Background:
- Crohn's disease is a chronic inflammatory bowel disease affecting children.
- Previous therapies, including 6-mercaptopurine, were often ineffective or poorly tolerated.
- Pediatric Crohn's disease requires effective and safe treatment options.
Purpose of the Study:
- To evaluate the clinical outcomes of pediatric Crohn's disease patients treated with subcutaneous methotrexate.
- To assess methotrexate's efficacy in patients refractory to other immunomodulators.
- To determine the safety and tolerability of subcutaneous methotrexate in children.
Main Methods:
- A cohort of 14 pediatric patients with extensive Crohn's disease was studied.
- Patients received low-dose, weekly, subcutaneous methotrexate after failing other treatments.
- Outcomes were measured using the Pediatric Crohn's Disease Activity Index and corticosteroid requirements.
Main Results:
- 64% of patients (9/14) showed clinical improvement with subcutaneous methotrexate.
- Methotrexate was effective in patients who failed or were intolerant to 6-mercaptopurine.
- Improvement was observed within 4 weeks, with some patients achieving sustained remission after dose tapering.
Conclusions:
- Subcutaneous methotrexate is a viable treatment option for pediatric Crohn's disease.
- It offers a potential therapeutic avenue for patients unresponsive to other immunomodulators.
- Further research into long-term outcomes and optimal dosing is warranted.
Objective:
The objective of this study was to describe the clinical outcome of children with Crohn's disease treated with subcutaneous methotrexate.
Subjects/Methods:
Fourteen patients (10 boys) with extensive Crohn's disease diagnosed at a mean age of 10.6 +/- 3.6 years had previously received various medical therapies for 4.3 +/- 4.0 years. Because of the severity of their disease, 6-mercaptopurine had been introduced but discontinued because of the patients' failure to respond (n = 11) or the development of pancreatitis (n = 3). Subsequently, low-dose, weekly, subcutaneous methotrexate was initiated. Pediatric Crohn's Disease Activity Index scores and prednisone requirement were followed as outcome measures.
Results:
Overall, 9 (64%) of the 14 patients showed improvement, including 6 (55%) of 11 patients who had previously received an adequate trial of 6-mercaptopurine and all three patients who were intolerant of 6-mercaptopurine. Improvement in clinical and laboratory measures occurred by 4 weeks and were similar whether (n = 8) or not (n = 6) the dose of corticosteroids was increased before the start of subcutaneous methotrexate. Three patients were tapered from their initial methotrexate dose after the minimization of corticosteroids and remain well. One patient receiving daily corticosteroids died suddenly after acute onset of illness. Among patients responding, methotrexate was discontinued because of side effects (n = 2) or electively (n = 2). Of the latter two patients, one has resumed methotrexate after disease relapse, whereas the other patient has had a sustained remission.
Conclusions:
Low-dose, weekly, subcutaneous methotrexate can induce remission in some pediatric patients with Crohn's disease who fail to adequately respond to other immunomodulator medications.