Use of methotrexate in refractory Crohn's disease: The Edinburgh experience

✍ Scribed by Shahida Din; Anna Dahele; Janice Fennel; Sue Aitken; Alan G. Shand; Ian D.R. Arnott; Jack Satsangi

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 187 KB
• Volume: 14
• Category: Article
• ISSN: 1078-0998
• DOI: 10.1002/ibd.20405

✦ Synopsis

Background:

In the two benchmark controlled trials in Crohn's disease (CD) supporting its use, methotrexate (MTX) was used as the immunosuppressant of choice in immunomodulatory-naive patients. However, in daily clinical practice MTX is used generally after thiopurine analogs have failed.

Methods:

The data are reported using intramuscular (IM) MTX (25 mg/week) in the induction of remission and oral MTX (15 mg/week) in 39 CD patients with a median age of 32 years, assessed retrospectively. In all, 97% patients had failed azathioprine and/or mercaptopurine therapy due to lack of efficacy in 14 (36%) and side effects in 24 (61%) patients; 21 patients (53%) were steroid-dependent with a median dose of 27.5 mg prednisolone/day for over a year.

Results:

In all, 72% of patients tolerated an induction regimen of 25 mg/week of IM MTX; 10% managed a reduced dose and 18% were intolerant. Remission was achieved in 71% of patients at 16 weeks. In the patients taking corticosteroids, withdrawal was achieved in 26% of patients and reduction in 47% at 16 weeks. Oral MTX therapy was continued in 22 patients after induction. In this group the probability of relapse was 78% at 50 weeks of oral therapy.

Conclusions:

Parenteral MTX therapy is efficacious in inducing remission in steroid-dependent CD patients, although its use is limited by side effects in Ϸ30% of patients. Low-dose oral therapy does not maintain long-term remission and is not a suitable alternative.