Methotrexate for induction of remission in refractory Crohn's disease

McDonald, John W.D.; Tsoulis, David J; MacDonald, John K; Feagan, Brian G.

doi:10.1002/14651858.cd003459.pub3

Cited by 42 publications

(32 citation statements)

References 28 publications

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“…Over thelastseveraldecades,therapeutic advances in the treatment of pediatric Crohn disease (CD) have included the widespread use of immunomodulators such as 6-mercaptopurine, azathioprine, and methotrexate. [1][2][3] More recently, the anti-tumor necrosis factor a (anti-TNFa) biological agents (eg, infliximab and adalimumab) have been adopted as a treatment of moderate to severe pediatric CD. 4 Although several studies on adult patients who have CD have shown a comparative benefit of anti-TNFa versus placebo 5 and thiopurines, 6 these same studies have not been done in children because of practical (time and cost) and ethical (withholding an efficacious treatment) challenges.…”

mentioning

confidence: 99%

Effectiveness of Anti-TNFα for Crohn Disease: Research in a Pediatric Learning Health System

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Studies on adult patients who have Crohn disease have shown a comparative benefit of antiTNFa versus placebo and thiopurines. These same studies have not been done in children, because of time, cost, and ethical (withholding an efficacious treatment) challenges. WHAT THIS STUDY ADDS:Anti-TNFa therapy administered in routine practice to children with Crohn disease was more effective than usual care at achieving clinical and corticosteroid-free remission. Using data from the ImproveCareNow learning health system for observational research is feasible and produces valuable evidence. abstract OBJECTIVES: ImproveCareNow (ICN) is the largest pediatric learning health system in the nation and started as a quality improvement collaborative. To test the feasibility and validity of using ICN data for clinical research, we evaluated the effectiveness of anti-tumor necrosis factor-a (anti-TNFa) agents in the management of pediatric Crohn disease (CD).METHODS: Data were collected in 35 pediatric gastroenterology practices (April 2007 to March 2012 and analyzed as a sequence of nonrandomized trials. Patients who had moderate to severe CD were classified as initiators or non-initiators of anti-TNFa therapy. Among 4130 patients who had pediatric CD, 603 were new users and 1211 were receiving anti-TNFa therapy on entry into ICN.RESULTS: During a 26-week follow-up period, rate ratios obtained from Cox proportional hazards models, adjusting for patient and disease characteristics and concurrent medications, were 1.53 (95% confidence interval [CI], 1.20-1.96) for clinical remission and 1.74 (95% CI, 1.33-2.29) for corticosteroid-free remission. The rate ratio for corticosteroid-free remission was comparable to the estimate produced by the adult SONIC study, which was a randomized controlled trial on the efficacy of anti-TNFa therapy. The number needed to treat was 5.2 (95% CI, 3.4-11.1) for clinical remission and 5.0 (95% CI, 3.4-10.0) for corticosteroid-free remission. CONCLUSIONS:In routine pediatric gastroenterology practice settings, anti-TNFa therapy was effective at achieving clinical and corticosteroidfree remission for patients who had Crohn disease. Using data from the ICN learning health system for the purpose of observational research is feasible and produces valuable new knowledge. Over thelastseveraldecades,therapeutic advances in the treatment of pediatric Crohn disease (CD) have included the widespread use of immunomodulators such as 6-mercaptopurine, azathioprine, and methotrexate. [1][2][3] More recently, the anti-tumor necrosis factor a (anti-TNFa) biological agents (eg, infliximab and adalimumab) have been adopted as a treatment of moderate to severe pediatric CD. 4 Although several studies on adult patients who have CD have shown a comparative benefit of anti-TNFa versus placebo 5 and thiopurines, 6 these same studies have not been done in children because of practical (time and cost) and ethical (withholding an efficacious treatment) challenges.The cost of anti-TNFa is in the range...

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Effectiveness of Anti-TNFα for Crohn Disease: Research in a Pediatric Learning Health System

et al. 2014

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“…Patients were not permitted to use any other therapy with the exception of antibiotics for 14 d in the case of active perianal disease. Patients reached similar conclusions a year later, but understood the limitations of the data on oral MTX and suggested further study [15] .…”

Section: Does Combination Mtx and Anti-tnf Therapy To Treat Crohn's Dmentioning

confidence: 61%

Use of methotrexate in inflammatory bowel disease in 2014: A User’s Guide

Swaminath¹

2014

WJGPT

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Methotrexate has been used an immunomodulator in many autoimmune diseases, including inflammatory bowel disease. However, many physicians are unfamiliar or uncomfortable with its use in the management of inflammatory bowel disease. We summarize the data for use of methotrexate in common clinical scenarios: (1) steroid dependant Crohn's disease (CD); (2) maintenance of remission in steroid free CD; (3) azathioprine failures in CD; (4) in combination therapy with Anti-TNF agents in CD; (5) decreasing antibody formation to Anti-TNF therapy in CD; (6) management of fistulizing disease in CD; and (7) as well as induction and maintenance of remission in ulcerative colitis. An easy to use algorithm is provided for the busy clinician to access and safely prescribe methotrexate for their inflammatory bowel disease patients.

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“…Seventeen percent of methotrexate patients withdrew due to adverse events compared to 2 % of patients on placebo (RR 8.00, 95 % CI 1.09 to 58.51) [82]. Studies using oral methotrexate failed to show significant benefit in inducing remission in CD patients [82].…”

Section: Azathioprine and Other Immunosuppressants May Induce Remissimentioning

confidence: 99%

Indian Society of Gastroenterology consensus statements on Crohn’s disease in India

Ramakrishna

Makharia

Ahuja

et al. 2015

Indian J Gastroenterol

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In 2012, the Indian Society of Gastroenterology's Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on Crohn's disease (CD). This consensus, produced through a modified Delphi process, reflects our current recommendations for the diagnosis and management of CD in India. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.

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Methotrexate for induction of remission in refractory Crohn's disease

Cited by 42 publications

References 28 publications

Effectiveness of Anti-TNFα for Crohn Disease: Research in a Pediatric Learning Health System

Effectiveness of Anti-TNFα for Crohn Disease: Research in a Pediatric Learning Health System

Use of methotrexate in inflammatory bowel disease in 2014: A User’s Guide

Indian Society of Gastroenterology consensus statements on Crohn’s disease in India

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