Is Methotrexate Effective For Pediatric Crohn's Disease in Clinical Practice?

Abstract

Aim: The objective of this study was to evaluate the clinical outcome of children with Crohn's disease (CD) treated with methotrexate after intolerance to or failure of thiopurine drugs. Methods: A retrospective review of medical charts was conducted. Patients with CD, previously treated with thiopurine drugs for maintenance of remission, were included. Thiopurine treatment was discontinued due to side effects or drug resistance. Subsequently, weekly methotrexate treatment (subcutaneous or oral) was initiated in 15 patients. Outcome measures were Pediatric Crohn's Disease Activity Index (PCDAI) scores and steroid requirement. Results: Nine males and 6 females, diagnosed at age of 10.7±3.8 years, were included. All patients had previously received steroids, and 7 patients received inflximab prior to methotrexate initiation. Ten patients received subcutaneous injections and 5 received oral therapy of 15-25 mg methotrexate. Duration of treatment was 14.1±11.7 months. Ten patients (66.6%) responded: 7 had complete remission and 3 had clinical response. PCDAI scores prior to and 8-10 weeks after therapy were 28.9±9.9 and 13.0±13.1, respectively (p=0.004). Duration of steroid free remission was 13.6±9.8 months. Two patients received treatment < than 8 weeks due to side effects: elevated LFT's and vomiting. Among patients responding, methotrexate was discontinued in 4 patients: 2 because of side effects (pancreatitis, vomiting, after 5 and 24 months) and 2 electively. Summary: Methotrexate is effective in clinical practice as a steroid sparing agent in children with Crohn's disease who fail to respond to thiopurine medications. Conclusions: Methotrexate is a reasonable alternative for maintenance of remission in pediatric Crohn's disease.