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Close monitoring of methotrexate urged for pediatric IBD patients
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Use of methotrexate to treat children with inflammatory bowel disease should be monitored closely to guard against hepatotoxicity, a meta-analysis determined.
“We identified that abnormal liver biochemistries occur in approximately 1 of 10 patients, leading to medication discontinuation in approximately half of those affected,” the researchers wrote. “We would suggest close monitoring for this adverse event both during initiation of the medication and with long-term use.”
The meta-analysis reviewed records from 12 studies involving 457 pediatric patients with ulcerative colitis (n=55) or Crohn’s disease (n=402) treated with methotrexate (MTX).
Fifty-seven patients were diagnosed with abnormal liver biochemistry as a marker of hepatotoxicity in nine studies. The researchers’ meta-analyzed estimate of patients who developed abnormal liver biochemistry was 10.2% (95% CI, 5.4%-18.5%). As a result, 6.4% of patients required dose reductions (95% CI, 4.3%-9.5%) and 4.5% required discontinuation (95%CI, 2.8%-7.2%).
Due to the heightened need for reduction and discontinuation, the researchers suggested physicians closely monitor usage.
“We suggest a protocol that would include liver biochemistry measurements at baseline, biweekly (for the first 4 weeks) and then every 2–3 months thereafter,” the researchers concluded. “As MTX therapy can be quite beneficial in maintaining long-term remission, its discontinuation should not be performed unnecessarily … we would suggest avoiding MTX use in children with pre-existing liver disease.”
The researchers also called for more prospective studies to better determine timing, dose and duration of MTX usage after controlling for baseline characteristics and disease intensity and duration.
Disclosure: The researchers report no relevant financial disclosures.
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