Methotrexate in paediatric ulcerative colitis: a retrospective survey at a single tertiary referral centre
Article first published online: 16 AUG 2010
© 2010 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 32, Issue 8, pages 1017–1022, October 2010
How to Cite
Aloi, M., Di Nardo, G., Conte, F., Mazzeo, L., Cavallari, N., Nuti, F., Cucchiara, S. and Stronati, L. (2010), Methotrexate in paediatric ulcerative colitis: a retrospective survey at a single tertiary referral centre. Alimentary Pharmacology & Therapeutics, 32: 1017–1022. doi: 10.1111/j.1365-2036.2010.04433.x
- Issue published online: 26 SEP 2010
- Article first published online: 16 AUG 2010
- Publication data Submitted 18 April 2010 First decision 8 May 2010 Resubmitted 22 July 2010 Accepted 25 July 2010
Aliment Pharmacol Ther 2010; 32: 1017–1022
Background Patients with ulcerative colitis often receive thiopurines as immunomodulators (IMs) to maintain remission and avoid corticosteroids. If unresponsive or intolerant to these agents, patients are treated with methotrexate, an antimetabolite never assessed in paediatric ulcerative colitis.
Aim To describe the experience with methotrexate in children with ulcerative colitis.
Methods Thirty-two patients (median age 13.9 years) received methotrexate. Pediatric Ulcerative Colitis Activity Index (PUCAI) and use of corticosteroids were the main outcomes evaluated at baseline and at 3, 6 and 12 months.
Results Indications to methotrexate were azathioprine unresponsiveness in 18 patients, azathioprine intolerance/toxicity in 10 and spondyloarthropathy in four. Response or remission was achieved in 72%, 63% and 50% of patients at 3, 6 and 12 months respectively. Mean PUCAI were 49.5 ± 23.3 at baseline and 32.9 ± 21.9, 29.5 ± 21.8 and 29.4 ± 19.9 at 3, 6 and 12 months respectively (P: 0.03). At the beginning of methotrexate, 16 patients (50%) received corticosteroids that were discontinued in 13 of them (81%) by 6 months. At the end of the study, 11 patients (33%) needed short courses of corticosteroids for disease relapse.
Conclusions Methotrexate may be useful in treating children with ulcerative colitis, although large, controlled trials are warranted to define better its effectiveness.