Methotrexate Treatment in Pediatric Crohn Disease Patients Intolerant or Resistant to Purine Analogues

Abstract

Methotrexate is beneficial in maintaining remission and steroid-sparing treatment in children with Crohn disease following failure of thiopurine therapy.

Methotrexate for treatment of atopic dermatitis in children and adolescents

“…From week 1 to 16, nausea and/or vomiting was reported in 34% of those in the methotrexate group, headache and nasopharyngeal symptoms were each reported in 23%, increased aminotransferase levels in 9%, and alopecia in 6%. A retrospective study of 25 patients aged <18 years with Crohn's disease who had previously failed purine analogues were subsequently treated with methotrexate (median dose 12.5 mg/m 2 ) along with folic acid found that nausea was the most common side effect, occurring in 9%; the next most common adverse event was persistently elevated transaminases in 6.2% . No infectious or hematological complications were reported over a mean treatment duration of 13.1 ± 8.7 months (range 0.5–36 months, median 12 months).…”

“…In a randomized study comparing methotrexate 0.5 mg/kg (and folic acid) with leflunomide for juvenile rheumatoid arthritis, no serious adverse events were reported in the methotrexate group, which included 47 children from week 0 to 16 and 37 children from week 16 to 48 . From week 1 to 16, nausea and/or vomiting was reported in 34% of those in the methotrexate group, headache and nasopharyngeal symptoms were each reported in 23%, increased aminotransferase levels in 9%, and alopecia in 6%.…”

“…Low‐dose methotrexate is now fairly well established as a second‐line treatment for atopic eczema in the adult population, although double‐blind placebo‐controlled studies are lacking. While methotrexate has well‐established safety and efficacy data for use in juvenile rheumatoid arthritis and pediatric Crohn's disease, there has been a paucity of data to support its use for atopic eczema in children. Recently, a case series of pediatric patients with discoid eczema reported its efficacy and safety …”

Methotrexate in the treatment of inflammatory bowel disease

“…Opublikowano również wiele badań retrospektywnych dotyczących skuteczności i bezpieczeństwa stosowania MTX w NChZJ [3,22,24,[35][36][37][38]. Oceniano w nich zwykle niejednorodne grupy chorych -zarówno z ChLC, jak i WZJG, a lek podawano w różnych dawkach i w różnej postaci (głównie doustnie, w średniej dawce ok. 20 mg/ tydz.).…”

“…Pokreślili też konieczność wyczerpującego informowania chorego na temat dawkowania leku, zakazu prokreacji i możliwości wystąpie-nia działań niepożądanych [22]. Także u dzieci po nieskutecznym leczeniu analogami puryn stwierdzono przydatność MTX w indukowaniu i podtrzymywaniu remisji choroby oraz bezpieczeństwo stosowania [38].…”