Methotrexate after thiopurine therapy in children with Crohn's disease: a multicenter cohort study.

Haisma, S.M. (2014) Methotrexate after thiopurine therapy in children with Crohn's disease: a multicenter cohort study. thesis, Medicine.

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Abstract

Background: Methotrexate (MTX) is an immunomodulating drug that can be used to maintain remission in patients with Crohn’s disease (CD). It is underused in the routine care of children with CD. Data on the efficacy and tolerability in children and teenagers are scarce. We assessed the clinical efficacy and tolerability of MTX monotherapy after thiopurine therapy in a large Dutch pediatric cohort. Methods: We analyzed data from 6 university and 4 general teaching hospitals on consecutive children and teenagers who received MTX after thiopurine ineffectiveness or intolerance. We assessed patient characteristics, tolerability and benefits of the treatment. Clinical benefit was defined as ongoing use of MTX without relapse, or intentional discontinuation of successful therapy before the end of the observation period. Results: We identified 113 consecutive children who started MTX therapy between 2002 and 2012. Median age at the start of MTX therapy was 14 years (range 7 to 17). The proportion of children with clinical benefits were 73%, 52%, and 29%, at 6, 12, and 24 months, respectively. Thirty-one children discontinued MTX because of intolerance. Nausea or vomiting around administration was the commonest adverse event in MTX-intolerant patients (48%). Failure of preceding thiopurine treatment was a predictor for CD relapse within 6 months after starting with MTX. Limitations: Nine patients were excluded from the Kaplan-Meier survival analysis for not being in remission at the start of the observation period. An objective appraisal of the remission-maintaining properties of MTX was not possible in these patients. Conclusions: Among pediatric CD patients who received MTX therapy after thiopurine, 52% still experienced clinical benefits 12 months after the start. Pre-emptive treatment with an anti-emetic to reduce adverse events was underused.

Item Type:	Thesis (Thesis)
Supervisor name:	Rheenen, Dr. P.F. van
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:46
Last Modified:	25 Jun 2020 10:46
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/755

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