Methotrexate for the treatment of refractory Crohn's disease.

Abstract

Methotrexate appears effective in most patients with refractory Crohn's disease and its short-term toxicity is acceptable, but the long-term benefit seems more limited.

Efficacy and tolerability of methotrexate therapy for refractory Crohn’s disease: a large single‐centre experience

“…14 Two larger studies, conducted in France and Scotland, 16,17 both reported response rates to therapy in the order of 70%, but approximately 40% were in remission at 12 months in the French cohort, 16 compared with only 20% in the Scottish study. 17 The higher remission rates in the French study may relate to the fact that the patients selected for inclusion were only those who exhibited a good initial response to methotrexate, with those with early relapse or intolerance to therapy excluded.…”

“…17 The higher remission rates in the French study may relate to the fact that the patients selected for inclusion were only those who exhibited a good initial response to methotrexate, with those with early relapse or intolerance to therapy excluded. 16 In another study, which administered 25 mg of intramuscular methotrexate to 14 patients with refractory CD for 12 weeks, 13 36% and 29% of patients achieved endoscopic and histological remission, respectively. Although these response rates are substantially lower, it should be noted that these outcome measures were appreciably more stringent than the clinical assessments conducted in most of the other studies, and in fact clinical response was achieved in approximately 80% of these patients at 3 months.…”

“…8,9 However, there have been few data from other RCTs since these studies were published, 10,11 and other investigators have reported variable efficacy of methotrexate in CD in nonrandomised studies. [12][13][14][15][16][17] Part of the explanation for these disparate results may relate to the route of administration used. Although the parenteral route of administration of methotrexate was used in the aforementioned RCTs, 8,9 this carries logistical complexities in practice, as patients have to be trained to self administer the drug, and be provided with appropriate facilities for its disposal due to its cytotoxicity.…”

Severe and Steroid-Resistant Crohn’s Disease

“…Additional reports on the utility of methotrexate in steroid-refractory patients are available, but these reports are mostly case series [81,82,83]. The remission rate in these three series which mostly included patients intolerant of or refractory to purine analogues was about 70%.…”

Severe and Steroid-Resistant Crohn’s Disease

“…Additional reports on the utility of methotrexate in steroid-refractory patients are available, but these reports are mostly case series [59,60,61]. The remission rate in these three series which included mostly patients intolerant of or refractory to purine analogues was about 70%.…”