Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, Illinois.
Pediatrics, SBH Health System, Bronx, New York.
Inflamm Bowel Dis. 2018 Sep 15;24(10):2135-2141. doi: 10.1093/ibd/izy078.
Methotrexate (MTX) is an immunomodulator used for the treatment of pediatric inflammatory bowel disease (IBD). There are currently no RCTs that assess the treatment efficacy of methotrexate within the pediatric IBD patient population. This systematic review and meta-analysis assesses the efficacy of MTX therapy among the existing pediatric literature.
A systematic literature search was performed using MEDLINE and the Cochrane library from inception until March 2016. Synonyms for 'pediatric', 'methotrexate' and 'IBD' were utilized as both free text and MESH search terms. The studies included contained clinical remission (CR) rates for MTX treatment of pediatric IBD patients 18 yrs old, as mono- or combination therapy. Case studies with <10 patients were excluded. Quality assessment was performed with the Newcastle-Ottawa Scale. Meta-analysis calculated pooled CR rates. A random-effects meta-analysis with forest plots was performed using R.
Fourteen (11 monotherapy, 1 combination therapy, 2 both; n = 886 patients) observational studies were eligible out of 202 studies. No interventional studies were identified. The pooled achieved CR rate for pediatric CD patients on monotherapy within 3-6 months was 57.7% (95% CI 48.2-66.6%), (P =0.22; I2 = 29.8%). The CR was 37.1% (95% CI 29.5-45.5%), (P = 0.20; I2 = 37.4%) for maintenance therapy at 12 months. Sub-analysis could not identify CR differences between MTX administration types, thiopurine exposure.
This meta-analysis demonstrated that, over 50% of pediatric Crohn's disease patients induced with methotrexate achieved clinical remission, while 12-month remission rate was only 37%. Prospective controlled interventional trials should assess treatment efficacy among patient subgroups. 10.1093/ibd/izy078_video1izy078.video15774883936001.
甲氨蝶呤（MTX）是一种免疫调节剂，用于治疗儿科炎症性肠病（IBD）。目前尚无 RCT 评估儿科 IBD 患者人群中甲氨蝶呤的治疗效果。本系统评价和荟萃分析评估了现有儿科文献中甲氨蝶呤治疗的疗效。
使用 MEDLINE 和 Cochrane 图书馆进行系统文献检索，检索时间从建库至 2016 年 3 月。使用“儿科”、“甲氨蝶呤”和“IBD”的同义词作为自由文本和 MESH 搜索词。纳入的研究包含 MTX 治疗儿科 IBD 患者的临床缓解（CR）率，作为单药或联合治疗。排除了<10 例患者的病例研究。使用纽卡斯尔-渥太华量表进行质量评估。荟萃分析计算了汇总的 CR 率。使用 R 进行随机效应荟萃分析和森林图。
在 202 项研究中，有 14 项（11 项单药治疗，1 项联合治疗，2 项均为；n = 886 例）观察性研究符合纳入标准。未发现干预性研究。3-6 个月内接受单药治疗的儿科 CD 患者的汇总 CR 率为 57.7%（95%CI 48.2-66.6%），（P = 0.22；I2 = 29.8%）。12 个月时维持治疗的 CR 率为 37.1%（95%CI 29.5-45.5%），（P = 0.20；I2 = 37.4%）。亚组分析未能确定 MTX 给药类型、硫嘌呤暴露之间的 CR 差异。
本荟萃分析表明，超过 50%的儿科克罗恩病患者用甲氨蝶呤诱导缓解，而 12 个月时的缓解率仅为 37%。应进行前瞻性对照干预试验，以评估患者亚组中的治疗效果。10.1093/ibd/izy078_video1izy078.video15774883936001.
