Metotrexato en la enfermedad inflamatoria intestinal pediátrica

Following the notification from the FDA on the risk of hepatosplenic T-cell lymphoma after using thiopurines, it has found a growing trend of prescribing MTX in paediatric inflammatory bowel disease, becoming the first-line immunomodulator in up to 60% of PIBD patients in 2010. The basic mechanism of action by which MTX acts in IBD and rheumatologic diseases is currently unknown, but it seems not to be exclusively by inhibiting the metabolism of folates. Side effects (nausea/vomiting, hypertransaminasaemia, leukopenia and thrombocytopenia) of treatment with MTX are currently the major factor that has conditioned the widespread use of MTX in PIBD. The purpose of this manuscript is to describe the pharmacological aspects of MTX, review the effectiveness of MTX in paediatric CD and UC in both mono and combination therapy, and highlight the most important aspects in terms of side effects and their management.