The efficacy of methotrexate for maintaining remission in inflammatory bowel disease
Version of Record online: 3 APR 2002
Alimentary Pharmacology & Therapeutics
Volume 16, Issue 4, pages 693–697, April 2002
How to Cite
Fraser, A. G. , Morton, D. , McGovern, D. , Travis, S. and Jewell, D. P. (2002), The efficacy of methotrexate for maintaining remission in inflammatory bowel disease. Alimentary Pharmacology & Therapeutics, 16: 693–697. doi: 10.1046/j.1365-2036.2002.01227.x
- Issue online: 3 APR 2002
- Version of Record online: 3 APR 2002
The management of patients with inflammatory bowel disease who are resistant to or intolerant of azathioprine remains a challenge. Low-dose methotrexate has been shown to be effective in inducing remission in Crohn's disease.
This review was conducted because there are limited long-term follow-up data during and after stopping treatment. There are also limited data on the use of methotrexate in ulcerative colitis.
The study was a retrospective review of clinical notes. Remission was defined as minimal bowel symptoms without the need for oral steroids for 3 months. Relapse was defined as bowel symptoms that required steroid treatment or surgery.
Seventy patients were reviewed; 48 had Crohn's disease and 22 had ulcerative colitis. The mean duration of treatment was 17.1 months; the mean maintenance dose was 20 mg weekly. Remission was achieved in 34 of 55 patients who completed more than 3 months of treatment (62%). Life-table analysis showed that the chances of remaining in remission at 12, 24 and 36 months (if treatment was continued) were 90%, 73% and 51%, respectively. The chances of remaining in remission after stopping treatment at 6, 12 and 18 months were 42%, 21% and 16%, respectively. The dose of methotrexate (mg/kg) was associated with the induction of remission (P=0.02). Treatment was equally effective for Crohn's disease and ulcerative colitis.
Maintenance methotrexate treatment gives acceptable remission rates for treatment periods up to 3 years. After stopping treatment, relapse is frequent and occurs early (usually within 1 year).