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.
Highlights
Crohn’s disease (CD) is an inflammatory disease of the gastrointestinal tract with a growing global incidence, ranging from 2.5 to 11.4 per 100,000 in the pediatric population [1]
More aggressive forms of CD are observed in children compared to adults
In the last two decades, there was a significant increase in the use of MTX as a first-line immunomodulatory drug in the treatment of pediatric CD, due to occurrence of hepatosplenic T-cell lymphoma (HSTCL) in some young male patients treated with TPs, independently or in combination with anti-tumor necrosis factor (TNF) agents, as well as because of clinical experience that indicates effectiveness and a good safety profile of MTX [2,3,4,5,6]
Summary
Crohn’s disease (CD) is an inflammatory disease of the gastrointestinal tract with a growing global incidence, ranging from 2.5 to 11.4 per 100,000 in the pediatric population [1]. In the last two decades, there was a significant increase in the use of MTX as a first-line immunomodulatory drug in the treatment of pediatric CD, due to occurrence of hepatosplenic T-cell lymphoma (HSTCL) in some young male patients treated with TPs, independently or in combination with anti-tumor necrosis factor (TNF) agents, as well as because of clinical experience that indicates effectiveness and a good safety profile of MTX [2,3,4,5,6].
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