The following is a summary of “Effectiveness and Safety of Methotrexate as the First-Line Immunomodulator of Maintenance Therapy in Pediatric Crohn Disease,” published in the May 2023 issue of Pediatrics by Choi, et al.

For a retrospective cohort study, researchers sought to evaluate the effectiveness and safety of methotrexate (MTX) as the first-line immunomodulator for maintenance therapy in pediatric patients with Crohn’s disease (CD).

A total of 64 pediatric CD patients who received MTX as the initial immunomodulator were included in this study. Clinical remission (CR) was assessed at weeks 14, 26, and 52, while mucosal healing (MH) was assessed at weeks 26 and 52.

Among the 64 patients treated with MTX, CR was achieved by 60.9% at week 14, with MH observed in 29.7% at week 26 and 27.8% at week 52. When comparing different age subtypes based on the Paris classification, the CR rate was higher in subtype A1a compared to other subtypes at week 26 (60.0% in A1a, 26.5% in A1b, 0% in A2; P = 0.038). No significant differences were found in disease location, behavior, or perianal involvement. Adverse effects were observed in 30 out of 64 (46.9%) patients, including one patient who discontinued MTX before 26 weeks due to side effects. Increased liver enzymes were seen in 25 patients (39.0%), leukopenia in 5 patients (7.8%), nausea in 5 patients (7.8%), skin erosion in 1 patient (1.6%), and headache in 1 patient (1.6%).

As the first-line immunomodulator, MTX appeared to be an effective and safe maintenance therapy for pediatric patients with CD. It demonstrated favorable clinical remission rates and mucosal healing, with manageable adverse effects.

Source: journals.lww.com/jpgn/Fulltext/2023/05000/The_Effectiveness_and_Safety_of_Methotrexate_as.8.aspx