Immunosuppressants
For children whose disease is not regulated by the use of a 5-ASA drug, the immune-suppressing drugs azathioprine (Imuran) or 6-mercaptopurine (6-MP, Purinethol) may be used as maintenance therapy. In addition, methotrexate (Rheumatrex) may be used for Crohn's disease. The use of these drugs in children is similar to their use in adult patients; side effects in children are consistent with those found in adults.6-MP is effective for inducing remission in pediatric patients and may eliminate the need for corticosteroid use. It may also help prevent a relapse of Crohn's disease after surgery. Azathioprine has been shown to extend the length of a "first" remission in young patients with Crohn's disease when used early in the disease course. Parents who have concerns about the potentially serious side effects of these drugs should discuss the risks and potential benefits with a pediatric gastroenterologist.
Methotrexate has not been studied extensively for pediatric IBD, but it has been used effectively as a treatment for pediatric rheumatoid arthritis. Methotrexate only needs to be administered once a week, but it is given by injection, which may prevent some patients from using it. Side effects in children tend to be similar to those experienced by adults--nausea, vomiting, and headache.
Infliximab
Infliximab (Remicade) is approved for use in pediatric patients between the ages of six and 17. Infliximab is typically used when other therapies have failed. It has been shown to be effective in treating children with moderate to severe Crohn's disease or ulcerative colitis. The side effects in children are similar to those in adults, including infection and allergic reaction.Sources:
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