Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Inflamm Bowel Dis. 2012 Aug;18(8):1488-92. doi: 10.1002/ibd.21885. Epub 2011 Aug 31.
Crohn's colitis refractory to anti-tumor necrosis factor alpha (TNF-α) therapy is commonly seen in tertiary care centers for pediatric inflammatory bowel disease (IBD). We report our experience in managing pediatric refractory Crohn's colitis with concomitant use of methotrexate and anti-TNF-α therapy.
We reviewed records from 2007 to 2010 at the Mayo Clinic pediatric IBD center. We included all patients with Crohn's disease (CD) failing anti-TNF-α therapy who then received concomitant methotrexate. The primary endpoint was clinical remission, defined as inactive disease in accordance with the short pediatric CD activity index (PCDAI). The secondary endpoint was last day of follow-up.
Fourteen patients with CD received concomitant methotrexate and anti-TNF-α treatment (age, mean [range], 15.7 [6-20] years; standard deviation [SD], 3.4 years). Mean age at diagnosis was 12.5 years (range, 3-17 years; SD, 3.83 years). The male-to-female ratio was 10:4. All patients had moderate to severe disease activity using the short PCDAI and had predominately Crohn's colitis. Twelve patients were previously treated with thiopurines (85.7%). Seven patients (50%) were in clinical remission within an average of 6 weeks postmethotrexate induction. Five patients (35.7%) experienced adverse events including nausea and headache, yet only one discontinued therapy due to adverse events. Infection with Clostridium difficile was common, complicating therapy in four patients (28.6%).
Concomitant use of methotrexate and anti-TNF-α therapy is a promising option for children with refractory Crohn's colitis.
在儿童炎症性肠病（IBD）的三级护理中心，经常会遇到对肿瘤坏死因子-α（TNF-α）治疗有抗药性的克罗恩病结肠炎。我们报告了我们在使用甲氨蝶呤和抗 TNF-α 联合治疗儿童难治性克罗恩病结肠炎方面的经验。
我们回顾了 2007 年至 2010 年在梅奥诊所儿科 IBD 中心的记录。我们纳入了所有对 TNF-α 治疗有抗药性的克罗恩病（CD）患者，这些患者随后接受了甲氨蝶呤联合治疗。主要终点是临床缓解，定义为根据短小儿 CD 活动指数（PCDAI）确定的无疾病活动。次要终点是最后一次随访日。
14 例 CD 患者接受了甲氨蝶呤和抗 TNF-α 联合治疗（年龄，均值[范围]，15.7 [6-20] 岁；标准差[SD]，3.4 岁）。平均诊断年龄为 12.5 岁（范围，3-17 岁；SD，3.83 岁）。男女比例为 10:4。所有患者的短 PCDAI 均显示为中重度疾病活动，且主要为克罗恩病结肠炎。12 例患者之前接受过硫嘌呤（85.7%）治疗。7 例（50%）患者在接受甲氨蝶呤诱导治疗后平均 6 周内达到临床缓解。5 例（35.7%）患者出现不良事件，包括恶心和头痛，但只有 1 例因不良事件停止治疗。艰难梭菌感染很常见，4 例（28.6%）患者的治疗因此受到影响。
甲氨蝶呤和抗 TNF-α 联合治疗是治疗难治性克罗恩病结肠炎儿童的一种很有前途的选择。
