Document Detail

Methotrexate in patients with Crohn's disease after 6-mercaptopurine.
MedLine Citation:
PMID:  9602195     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The objective of this study was to describe the clinical outcome of children with Crohn's disease treated with subcutaneous methotrexate. SUBJECTS/METHODS: Fourteen patients (10 boys) with extensive Crohn's disease diagnosed at a mean age of 10.6 +/- 3.6 years had previously received various medical therapies for 4.3 +/- 4.0 years. Because of the severity of their disease, 6-mercaptopurine had been introduced but discontinued because of the patients' failure to respond (n = 11) or the development of pancreatitis (n = 3). Subsequently, low-dose, weekly, subcutaneous methotrexate was initiated. Pediatric Crohn's Disease Activity Index scores and prednisone requirement were followed as outcome measures. RESULTS: Overall, 9 (64%) of the 14 patients showed improvement, including 6 (55%) of 11 patients who had previously received an adequate trial of 6-mercaptopurine and all three patients who were intolerant of 6-mercaptopurine. Improvement in clinical and laboratory measures occurred by 4 weeks and were similar whether (n = 8) or not (n = 6) the dose of corticosteroids was increased before the start of subcutaneous methotrexate. Three patients were tapered from their initial methotrexate dose after the minimization of corticosteroids and remain well. One patient receiving daily corticosteroids died suddenly after acute onset of illness. Among patients responding, methotrexate was discontinued because of side effects (n = 2) or electively (n = 2). Of the latter two patients, one has resumed methotrexate after disease relapse, whereas the other patient has had a sustained remission. CONCLUSIONS: Low-dose, weekly, subcutaneous methotrexate can induce remission in some pediatric patients with Crohn's disease who fail to adequately respond to other immunomodulator medications.
D R Mack; R Young; S S Kaufman; L Ramey; J A Vanderhoof
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of pediatrics     Volume:  132     ISSN:  0022-3476     ISO Abbreviation:  J. Pediatr.     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-06-18     Completed Date:  1998-06-18     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  830-5     Citation Subset:  AIM; IM    
Department of Pediatrics, University of Nebraska Medical Center, Omaha 68198-5160, USA.
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MeSH Terms
6-Mercaptopurine / therapeutic use*
Child, Preschool
Crohn Disease / drug therapy*
Drug Therapy, Combination
Immunosuppressive Agents / administration & dosage,  therapeutic use*
Injections, Subcutaneous
Methotrexate / administration & dosage,  therapeutic use*
Prospective Studies
Remission Induction
Risk Factors
Treatment Outcome
Grant Support
Reg. No./Substance:
0/Immunosuppressive Agents; 50-44-2/6-Mercaptopurine; 59-05-2/Methotrexate

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