TY - JOUR T1 - Efficacy of oral methotrexate in paediatric Crohn’s disease: a multicentre propensity score study JF - Gut JO - Gut SP - 1898 LP - 1904 DO - 10.1136/gutjnl-2014-307964 VL - 64 IS - 12 AU - Dan Turner AU - Etti Doveh AU - Ayala Cohen AU - Michelle L Wilson AU - Andrew B Grossman AU - Joel R Rosh AU - Ying Lu AU - Athos Bousvaros AU - Colette Deslandres AU - Angela Noble AU - Robert N Baldassano AU - Arie Levine AU - Aaron Lerner AU - David C Wilson AU - Anne M Griffiths Y1 - 2015/12/01 UR - http://gut.bmj.com/content/64/12/1898.abstract N2 - Background Oral methotrexate (MTX) administration avoids weekly injections, reduces costs and may improve quality of life of patients with Crohn’s disease (CD), especially children. Routes of administration have never been systematically compared in CD. We aimed to compare effectiveness and safety of orally (PO) versus subcutaneously (SC) administered MTX in paediatric CD.Methods 226 children with CD treated with oral or subcutaneous MTX were included in a multicentre, retrospective 1-year cohort study (62% boys, mean age 13.8±2.8 years, 88% previous thiopurines). 38 (17%) were initially commenced on oral, 98 (43%) started subcutaneous and switched to oral and 90 (40%) were treated with subcutaneous only. Matching and ‘doubly robust’ weighted regression models were based on the propensity score method, controlling for confounding-by-indication bias. 11/23 pretreatment variables were different between the groups, but the propensity score modelling successfully balanced the treatment groups.Results 76 children (34%) had sustained steroid-free remission with a difference that did not reach significance between the PO and the SC groups (weighted OR=1.72 (95% CI 0.5 to 5.9); p=0.52). There were no differences in need for treatment escalation (p=0.24), elevated liver enzymes (p=0.59) or nausea (p=0.85). Height velocity was lower in the PO group (p=0.006) and time to remission was delayed in the PO group (p=0.036; Fleming (0, 1) test).Conclusions In this largest paediatric CD cohort to date, SC administered MTX was superior to PO, but only in some of the outcomes and with a modest effect size. Therefore, it may be reasonable to consider switching children in complete remission treated with subcutaneous MTX to the oral route with close monitoring of inflammatory markers and growth. ER -