PMID- 20706154
OWN - NLM
STAT- MEDLINE
DCOM- 20110510
LR  - 20191210
IS  - 1536-4801 (Electronic)
IS  - 0277-2116 (Linking)
VI  - 51
IP  - 6
DP  - 2010 Dec
TI  - A single-center experience with methotrexate after thiopurine therapy in 
      pediatric Crohn disease.
PG  - 714-7
LID - 10.1097/MPG.0b013e3181dd861a [doi]
AB  - BACKGROUND AND AIM: Thiopurines are a common, effective means of maintaining 
      remission in pediatric Crohn disease (CD). Methotrexate (MTX) may be considered 
      for those intolerant of or unresponsive to thiopurines. The purpose of this study 
      was to examine the effectiveness of MTX as maintenance therapy in patients 
      previously treated with thiopurines. PATIENTS AND METHODS: All of the patients at 
      Nationwide Children's Hospital from 1998 to 2007 with an International 
      Classification of Diseases code indicative of CD were identified. Patients with a 
      diagnosis of CD, a history of prior thiopurine use, no current infliximab 
      therapy, and at least 6 months of follow-up after MTX initiation were included. 
      The primary outcome was defined as steroid-/infliximab-free remission determined 
      by the physician global assessment at 6 and 12 months. Secondary outcomes 
      included subsequent treatment with infliximab and/or corticosteroids, rate of 
      discontinuation of MTX, and adverse events (AEs). RESULTS: Twenty-seven patients 
      (17 boys, 63%) with a mean age at diagnosis of 12.3 +/- 0.7 years and mean disease 
      duration of 1.49 +/- 0.3 years were identified. Indications for MTX included 
      nonresponse to thiopurines, AE, and poor adherence to thiopurines. At 6 and 12 
      months, 13 of 27 patients (48.1%) and 9 of 27 patients (33.3%), respectively, 
      were in steroid-/infliximab-free remission. A total of 10 patients (37.0%) 
      required infliximab therapy during the 12-month period and 5 patients 
      discontinued MTX. Nausea was the most commonly reported AE. Transient 
      transaminase elevation occurred in 4 patients and transient leukopenia in 2 
      patients. CONCLUSIONS: MTX can be effective as maintenance therapy for patients 
      with pediatric CD previously intolerant of or unresponsive to thiopurines; 
      however, greater than one third of this cohort required escalation to antitumor 
      necrosis factor therapy within 12 months following MTX initiation. MTX was well 
      tolerated.
FAU - Boyle, Brendan
AU  - Boyle B
AD  - Department of Pediatrics, Division of Pediatric Gastroenterology, Nationwide 
      Children's Hospital, Columbus, OH, USA. brendan.boyle@nationwidechildrens.org
FAU - Mackner, Laura
AU  - Mackner L
FAU - Ross, Christina
AU  - Ross C
FAU - Moses, Jonathan
AU  - Moses J
FAU - Kumar, Soma
AU  - Kumar S
FAU - Crandall, Wallace
AU  - Crandall W
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Pediatr Gastroenterol Nutr
JT  - Journal of pediatric gastroenterology and nutrition
JID - 8211545
RN  - 0 (Antibodies, Monoclonal)
RN  - B72HH48FLU (Infliximab)
RN  - E7WED276I5 (Mercaptopurine)
RN  - EC 2.1.1.- (Methyltransferases)
RN  - EC 2.6.1.- (Transaminases)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
MH  - Antibodies, Monoclonal/therapeutic use
MH  - Child
MH  - Crohn Disease/*drug therapy
MH  - *Drug Tolerance
MH  - Female
MH  - Humans
MH  - Infliximab
MH  - Leukopenia/etiology
MH  - Male
MH  - Mercaptopurine/adverse effects/*therapeutic use
MH  - Methotrexate/adverse effects/*therapeutic use
MH  - Methyltransferases/therapeutic use
MH  - Nausea/chemically induced
MH  - Outcome Assessment, Health Care
MH  - Patient Compliance
MH  - Remission Induction
MH  - Retrospective Studies
MH  - Transaminases/metabolism
EDAT- 2010/08/14 06:00
MHDA- 2011/05/11 06:00
CRDT- 2010/08/14 06:00
PHST- 2010/08/14 06:00 [entrez]
PHST- 2010/08/14 06:00 [pubmed]
PHST- 2011/05/11 06:00 [medline]
AID - 10.1097/MPG.0b013e3181dd861a [doi]
PST - ppublish
SO  - J Pediatr Gastroenterol Nutr. 2010 Dec;51(6):714-7. doi: 
      10.1097/MPG.0b013e3181dd861a.