title: Methotrexate is an efficient therapeutic alternative in children with thiopurine-resistant Crohn's disease.
abstract: OBJECTIVE
  This study aimed to investigate the role of methotrexate (MTX) in the maintenance of clinical remission and mucosal healing in children with Crohn's disease (CD), in whom azathioprine (AZA) treatment failed.
  
  
  METHODS
  This was a retrospective, longitudinal cohort study which included all children who were diagnosed with CD during a period of 10 years and who received MTX for ≥12 months after failed AZA treatment. Remission was assessed clinically, defined by Pediatric Crohn's Disease Activity Index as a score of ≤10 and no need for the reintroduction of the remission induction therapy. In the subset of patients with sustained clinical remission, the rate of mucosal healing was endoscopically assessed. Endoscopic lesions were assessed by Simple Endoscopic Score for CD. Each patient served as his or her own historical control.
  
  
  RESULTS
  Of the 32 included patients, 22 (68.7%) remained in the stable clinical remission after a period of 12 months and 14 (43.8%) did not experience relapse during the whole follow up (median duration 2.9 years; range 1-4.8 years). From all patients who were in clinical remission during the entire follow up (n = 14), endoscopy was performed in eight (57%) patients and showed complete mucosal healing macroscopically (Simple Endoscopic Score for CD score of 0) and microscopically in seven out of eight (87.5%) patients.
  
  
  CONCLUSIONS
  MTX was found to be an efficient therapeutic alternative in the thiopurine-resistant patients, enabling the complete mucosal healing.
authors: Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School , Zagreb , Croatia.
authors: Iva
authors: I
authors: Hojsak
authors: Zrinjka
authors: Z
authors: Mišak
authors: Oleg
authors: O
authors: Jadrešin
authors: Ana
authors: A
authors: Močić Pavić
authors: Sanja
authors: S
authors: Kolaček
mesh_terms: D001379:Azathioprine / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003424:Crohn Disease / Q000175:diagnosis* / Q000188:drug therapy*; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine; D008727:Methotrexate
keywords: Children; Crohn’s disease; methotrexate