The main role of therapy in Crohn's disease (CD) is to achieve long-term clinical remission, and to allow for normal growth and development of children. The immunomodulatory drugs used for the maintenance of remission in CD include thiopurines (azathioprine and 6-mercaptopurine) and methotrexate (MTX). Development of hepatosplenic T-cell lymphoma in some patients with inflammatory bowel disease, treated with thiopurines only or in combination with anti-tumor necrosis factor agents, resulted in a growing interest in the therapeutic application of MTX in children suffering from CD. This review summarizes the literature on the therapeutic role of MTX in children with CD. MTX is often administered as a second-line immunomodulator, and 1-year clinical remission was reported in 25-69% of children with CD after excluding for the use of thiopurines. Initial data on MTX effectiveness in mucosal healing, and as a first-line immunomodulator in pediatric patients with CD, are promising. A definite conclusion, however, may only be made on the basis of additional research with a larger number of subjects.

中文翻译：

---

甲氨蝶呤在小儿克罗恩病中的治疗作用。

在克罗恩病（CD）中，治疗的主要作用是实现长期的临床缓解，并使儿童正常生长发育。用于维持CD缓解的免疫调节药物包括硫嘌呤（硫唑嘌呤和6-巯基嘌呤）和甲氨蝶呤（MTX）。在仅使用硫嘌呤或与抗肿瘤坏死因子药物联合治疗的一些炎症性肠病患者中，肝脾T细胞淋巴瘤的发展引起了对MTX在患有CD的儿童中的治疗应用的兴趣日益增长。这篇综述总结了关于MTX在CD儿童中的治疗作用的文献。MTX通常作为二线免疫调节剂使用，据报道，有25-69％的CD儿童在排除使用硫嘌呤后获得了1年的临床缓解。关于MTX在粘膜愈合中的有效性以及作为CD患儿的一线免疫调节剂的初步数据是有希望的。但是，只有在大量研究的基础上进行附加研究才能得出明确的结论。