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Review
. 2018 Aug 1;18(3):211-216.
doi: 10.17305/bjbms.2018.2792.

Therapeutic role of methotrexate in pediatric Crohn's disease

Zlatko Djurić  1 , Ljiljana Šaranac, Ivana Budić, Voja Pavlović, Jelena Djordjević
Affiliations
Review

Therapeutic role of methotrexate in pediatric Crohn's disease

Zlatko Djurić et al. Bosn J Basic Med Sci. .

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.

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Figures

FIGURE 1
FIGURE 1
Endoscopic appearance of Crohn’s disease (aphthous ulcers) in the descending colon of a 14-year-old male.
FIGURE 2
FIGURE 2
Endoscopic appearance of severe Crohn’s disease (deep serpiginous ulcers and cobblestoning) in the terminal ileum of a 16-year-old male.
See this image and copyright information in PMC

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Supplementary concepts