Long-term Methotrexate for Crohn's Disease: Safety and Efficacy in Clinical Practice

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http://www.jcge.com/pt/re/jclngastro/abstract.00004836-200804000-00013.htm;jsessionid=HrxHp4JRTxFKPhdph8vQ0wct2qRbLpnyw9d73dyyjFTnB2vCvVyW!923867264!181195629!8091!-1

Long-term Methotrexate for Crohn's Disease: Safety and Efficacy in Clinical Practice.

ALIMENTARY TRACT

Journal of Clinical Gastroenterology. 42(4):395-399, April 2008.Domenech, Eugeni MD, PhD; Manosa, Miriam MD; Navarro, Merce MD; Masnou, Helena MD; -Planella, Esther MD; Zabana, Yamile MD; Cabre, Eduard MD, PhD; Gassull, Miquel A. MD, PhD

Abstract: Goals: To assess the efficacy and safety profile of methotrexate (MTX) for the treatment of Crohn's disease (CD) in clinical practice. Background: MTX is widely used for some chronic immunologic diseases. Although some randomized controlled trials suggest its efficacy in CD, this drug remains a second-line, underused, immunomodulator. Study: Medical records of all patients treated with MTX for CD in our center (n=44) were reviewed. Clinical and epidemiologic parameters, including risk factors for hepatotoxicity, were registered. Results: MTX was prescribed mainly for steroid-dependency (n=22) and as concomitant treatment to infliximab (n=18). Mean duration of treatment was 22.9+/-19 months, with a mean cumulative dose of MTX of 1169+/-784 mg. Thirty-nine percent of patients developed drug-related side effects, hepatotoxicity being the most frequent [13 patients (30%)]. However, only 5 patients (11%) had to discontinue MTX. In steroid-dependent CD patients, disease remission and complete steroid withdrawal was achieved in 77% of cases. Seven patients lost their initial response to MTX during follow-up, leading to a cumulative probability of remission of 39% after 3 years of treatment. Conclusions: MTX is well tolerated in most CD patients. Although a great proportion of steroid-dependent CD patients achieve disease remission and steroid withdrawal, there is a trend to a loss of efficacy with time. Larger, long-term studies are necessary to establish the role of MTX in the management of CD. © 2008 Lippincott & Wilkins, Inc.