Use of Methotrexate in Children and Young Adults Affected by Ulcerative Colitis: A Retrospective Study
Bibliographic record
Abstract
Purpose: Methotrexate (MTX) is an immunosopressive drug used in patients affected by inflammatory bowel diseases(IBD). Several studies have demonstrated that MTX is effective in inducing and maintaining remission in Crohn's disease but data are insufficient to prove MTX efficacy in ulcerative colitis (UC). The aim of this study was to evaluate MTX effectiveness in inducing and maintaining clinical and endoscopic remission in children and young adults with steroid-dependent or steroidresistant UC. Methods: A retrospective study has been performed in a group of patients aged less than 16 years and affected by steroid-dependent or steroidresistant UC, treated with intramuscular methotrexate at dose of 20 mg/m2 week between 1995 and 2011. Clinical remission was defined as discontinuation of steroids and achievement of S0 stage of Montreal classification after 3, 6 and 12 months. Endoscopic remission was defined as achievement of level 0 of Baron score at the same timing of clinical score calculation. Results: 17 patients (mean age 7.5±4.95 years, female 64.7%, male 35.3%) were analyzed. All patients resulted steroid-resistant or steroid-dependent and were treated with mesalamine, except 2. One patient was previously treated with purine analogs without benefit; none had been previously treated with anti-tumor necrosis factor. After 3 months of therapy, MTX induced clinical and endoscopic remission in 82% and 71% of UC patients, respectively. Nine UC patients continued MTX therapy for more than 3 months. After 6 months of treatment, 56% of patients maintained clinical and endoscopic remission while the S2 and S1 stages were detected in 11% and 33% of patients, respectively. 33% of patients presented a score 1 of Baron 6 months after initiation of MTX. The 1 year clinical and endoscopic remission was observed in 33% of patients. On MTX therapy, 1 patient presented acute pancreatitis and discontinued treatment. Conclusion: MTX seems to be an efficacy drug in inducing clinical and endoscopic remission in pediatric UC, despite in our study the long-term treatment rate with MTX was low. More studies are needed to evaluate MTX efficacy in inducing and maintaining clinical and endoscopic remission in pediatric UC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".