Paediatric gastroenterologist Tim de Meij and immunologist and clinical pharmacologist Maja Bulatović Ćalasan are working together to improve the treatment of children with Crohn's disease. Their goal is to fine-tune the use of a commonly-used medication to optimise its effect with the fewest possible side effects.
Medication
Children with Crohn's disease regularly suffer from flare-ups of inflammation in the intestines. The consequences can be serious and the disease has a major impact on daily life. Paediatrician Tim de Meij explains that there are actually only a limited number of medications available for these children, especially compared to adults: ‘We want to utilise the medications that are available as optimally as possible. That means a good effect on the inflammation with as few side effects as possible. That is why we started this study.’ Maja Bulatović adds: ’We are going to study methotrexate, or MTX for short. This medication is already widely used in both adults and children with Crohn's disease, but it is currently difficult to determine the correct dosage for children because it is not currently possible to use the MTX level in the blood to do so.‘ In this study, we are trying to change this and create new guidelines.’
Expert
MTX is particularly effective on the immune system, Bulatović Ćalasan explains: ‘Crohn's disease is an autoimmune disease. This means that the immune system reacts too actively in this disease, causing inflammation. MTX inhibits the activity of white blood cells, and also reduces inflammatory factors.’ Bulatović Ćalasan is an expert in the field of MTX: ‘I also researched this drug for children and adults with rheumatism, and also for adults with Crohn's disease. I am very pleased that the Dutch Digestive Health Fund has now made funds available for this research for children with Crohn's disease. The drug MTX is very effective, but the problem has always been that it was not possible to measure the levels, i.e. the amount of the drug in the blood, to make optimal use of MTX. This made it difficult to determine the correct dose. For adults, there are now clear guidelines for the dose of MTX for Crohn's disease. Now we want to achieve the same for children with this disease. It is not the technique, because fortunately we can now determine the levels of MTX. If we now measure the levels in a sufficient number of patients, we can ultimately draw up clear guidelines for this medication in children with Crohn's disease. Not too much, not too little: a dosage that is just right."
More than a hundred children
‘We want to involve more than a hundred children in this study,’ says De Meij. ’That means that several hospitals will participate. We are going to look at both children who only use MTX and children who use MTX in combination with other medications. Ultimately, we hope to optimise treatment with MTX through this research. That means more effect and fewer side effects. This research is therefore very much in line with the needs of patients, their parents and practitioners. A previously drawn up national research agenda for children with Crohn's disease shows that more effective medicines with fewer side effects are at the top of their wish list.’
Global benefits
Bulatović Ćalasan emphasises that MTX has already proven its worth: ‘It has been on the market for over 50 years and its effect has been well proven.’ And De Meij looks beyond the Netherlands: ‘There is a lot of research being done into medicines around the world. This often involves new, extremely expensive drugs. Only the richest countries can ultimately benefit from this. MTX is a relatively cheap drug. I think it is good that we are investigating this particular drug for this target group. Ultimately, it could benefit people all over the world.’