Efficacy of methotrexate in Crohn’s disease and ulcerative colitis patients unresponsive or intolerant to azathioprine /mercaptopurine
Article first published online: 23 JUN 2009
© 2009 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 30, Issue 6, pages 614–620, September 2009
How to Cite
WAHED, M., LOUIS-AUGUSTE, J. R., BAXTER, L. M., LIMDI, J. K., MCCARTNEY, S. A., LINDSAY, J. O. and BLOOM, S. L. (2009), Efficacy of methotrexate in Crohn’s disease and ulcerative colitis patients unresponsive or intolerant to azathioprine /mercaptopurine. Alimentary Pharmacology & Therapeutics, 30: 614–620. doi: 10.1111/j.1365-2036.2009.04073.x
- Issue published online: 18 AUG 2009
- Article first published online: 23 JUN 2009
- Publication data Submitted 2 March 2009 First decision 21 March 2009 Resubmitted 18 June 2009 Accepted 20 June 2009 Epub Accepted Article 23 June 2009
Background Despite the wide use of azathioprine/mercaptopurine (AZA/MP) therapy in the management of both Crohn’s disease (CD) and ulcerative colitis (UC), approximately 20% of patients cannot tolerate the drugs and 30% do not respond.
Aim To examine the efficacy and safety profile of methotrexate (MTX) in patients with CD or UC who are either intolerant or non-responsive to AZA/MP.
Methods A total of 131 patients with IBD treated with MTX were identified. Retrospective data were obtained by case note review. Clinical response (defined as steroid withdrawal, normalization of previously raised CRP or physician’s clinical assessment of improvement) was assessed at 6 months.
Results Clinical response in Crohn’s disease occurred in 18 of 29 patients (62%) refractory to AZA/MP and 42 of 70 patients (60%) intolerant to AZA/MP, with no difference between the groups (P = 1.0). In UC, clinical response was seen in 7 of 9 (78%) patients refractory to AZA/MP and 15 of 23 (65%) intolerant to thiopurines. MTX was well tolerated in a majority of individuals.
Conclusions Methotrexate appears effective in both CD and UC patients who fail to respond to or are intolerant to AZA/MP therapy.