Efficacy of parenteral methotrexate in refractory Crohn’s disease
Article first published online: 7 JUL 2008
Alimentary Pharmacology & Therapeutics
Volume 15, Issue 1, pages 35–44, January 2001
How to Cite
Chong, R. Y., Hanauer, S. B. and Cohen, R. D. (2001), Efficacy of parenteral methotrexate in refractory Crohn’s disease. Alimentary Pharmacology & Therapeutics, 15: 35–44. doi: 10.1046/j.1365-2036.2001.00908.x
- Issue published online: 7 JUL 2008
- Article first published online: 7 JUL 2008
Methotrexate is steroid-sparing in short-term trials for refractory Crohn’s disease. This study assesses the impact of dosing and administration on the long-term utility of methotrexate in Crohn’s disease.
The efficacy and tolerability of methotrexate were assessed in all refractory Crohn’s disease patients treated at the University of Chicago from 1 September 1989 to 6 June 1997.
Seventy-six patients were identified: 43% male, mean age 35 years, mean Crohn’s disease duration 9.5 years. Mean methotrexate duration was 55 weeks; mean dose was 20 mg/week. Drug administration was parenteral (78%), oral (13%), or combination (8%). Improvement occurred in 63% after a mean of 9 weeks, for a mean duration of 65 weeks. Remission occurred in 37% after a mean of 22 weeks, for a mean duration of 59 weeks. Improvement and remission were highest with parenteral therapy, but dose-independent. Parenteral therapy maintained remission in 46%. Improvement (P=0.05) and remission (P=0.01) were more likely for patients under 40. Improvement rates were higher with concurrent steroids (P=0.02) or antibiotics (P=0.01). Side-effects occurred in 46%, resulting in discontinuation in 18%. Prednisone was decreased in 78%, and stopped in 40%.
Long-term therapy with methotrexate in Crohn’s disease is safe, effective, steroid-sparing, and most efficacious in younger patients and when given parenterally.