Methotrexate for Maintaining Remission in Paediatric Crohn's Patients with Prior Failure or Intolerance to Thiopurines: A Multicenter Cohort Study

Sjoukje-Marije Haisma, Thijs Lijftogt, Angelika Kindermann, Gerard Damen, Lissy de Ridder, Johanna C. Escher, M. Luisa Mearin, Tim de Meij, Daniëlle Hendriks, Elvira George, Thalia Hummel, Obbe Norbruis, Patrick van Rheenen

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Background and aims: Methotrexate [MTX] is an immunomodulating drug that can be used to maintain remission in patients with Crohn's disease [CD], but data on efficacy and tolerability in children and teenagers are scarce. We evaluated the long-term efficacy and tolerability of MTX monotherapy after thiopurine therapy in paediatric CD patients. Methods: A multicenter cohort of paediatric MTX users who stopped thiopurines due to ineffectiveness or intolerance between 2002 and 2012 were included and followed for at least 12 months. Relapse-free use was defined as steroid and biologics-free clinical remission after the introduction of MTX, and included intentional discontinuation of successful therapy before the end of the observation period. Results: A total of 113 patients with CD in remission were followed while on MTX monotherapy, of whom 75 [66%] had failed on thiopurines and 38 [34%] had stopped thiopurines due to side effects. Median age at the introduction of MTX was 14 years [range 7 to 17], and 93% used the subcutaneous route. Kaplan-Meier analysis showed that 52% of the study cohort were still in steroid-and biologics-free remission after 12 months of MTX monotherapy, with a difference that did not reach significance between thiopurine-intolerant and thiopurine-failing patients [p = 0.21, log-rank test]. Conclusions: The findings of this cohort study suggest that MTX is an effective immunomodulator to maintain remission after stopping thiopurines. MTX maintenance should be considered before stepping up to anti-tumor necrosis factor alpha therapy. MTX is probably somewhat more effective in patients who stopped thiopurines due to side effects than in those who failed on thiopurines
Original languageEnglish
Pages (from-to)305-311
JournalJournal of Crohn s & colitis
Issue number4
Publication statusPublished - 2015

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