Use of methotrexate in refractory Crohn's disease: The Edinburgh experience
Version of Record online: 14 FEB 2008
Copyright © 2008 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 14, Issue 6, pages 756–762, June 2008
How to Cite
Din, S., Dahele, A., Fennel, J., Aitken, S., Shand, A. G., Arnott, I. D.R. and Satsangi, J. (2008), Use of methotrexate in refractory Crohn's disease: The Edinburgh experience. Inflamm Bowel Dis, 14: 756–762. doi: 10.1002/ibd.20405
- Issue online: 5 MAY 2008
- Version of Record online: 14 FEB 2008
- Manuscript Accepted: 26 DEC 2007
- Manuscript Received: 19 OCT 2007
- Crohn's disease;
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 ≈30% of patients. Low-dose oral therapy does not maintain long-term remission and is not a suitable alternative.
(Inflamm Bowel Dis 2008)