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

Inflamm Bowel Dis. 2008 Jun;14(6):756-62. doi: 10.1002/ibd.20405.

Abstract

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 approximately 30% of patients. Low-dose oral therapy does not maintain long-term remission and is not a suitable alternative.

MeSH terms

  • Adolescent
  • Adult
  • Antibodies, Monoclonal / administration & dosage
  • Azathioprine / administration & dosage
  • Crohn Disease / drug therapy*
  • Female
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use*
  • Infliximab
  • Injections, Intramuscular
  • Male
  • Methotrexate / administration & dosage
  • Methotrexate / therapeutic use*
  • Prednisolone / therapeutic use
  • Remission Induction
  • Retrospective Studies

Substances

  • Antibodies, Monoclonal
  • Immunosuppressive Agents
  • Prednisolone
  • Infliximab
  • Azathioprine
  • Methotrexate