Methotrexate in Crohn's Disease: Long-Term Efficacy and Toxicity

Lémann, Marc; Zenjari, Taoufik; Bouhnik, Yoram; Cosnes, Jacques; Mesnard, B; Rambaud, Jean–Claude; Modigliani, R; Cortot, Antoine; Colombel, Jean–Frédéric

doi:10.1111/j.1572-0241.2000.02190.x

Cited by 87 publications

(97 citation statements)

References 14 publications

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“…[26][27][28][29] Indeed, methotrexate has been shown to have a steroidsparing effect 23 and this compound could provide prolonged remission. 28,30 Although the duration of treatment is not defined, two main reasons can lead to discontinue the drug. First, the long-term duration of treatment with methotrexate may expose patients to side effects related to high cumulative doses leading then to withdrawal.…”

Section: Discussionmentioning

confidence: 99%

“…First, the long-term duration of treatment with methotrexate may expose patients to side effects related to high cumulative doses leading then to withdrawal. 28,30 Secondly, an increasing proportion of patients become methotrexate-refractory with time. 28,30,31 This secondary loss of response to methotrexate could be related to partial efficacy of the drug, characterised by symptom relief without complete mucosal healing, as suggested here.…”

Section: Discussionmentioning

confidence: 99%

“…28,30 Secondly, an increasing proportion of patients become methotrexate-refractory with time. 28,30,31 This secondary loss of response to methotrexate could be related to partial efficacy of the drug, characterised by symptom relief without complete mucosal healing, as suggested here. The route of administration probably cannot explain the low rate of complete endoscopic healing observed as all the included patients were treated parenterally (subcutaneous and ⁄ or intramuscular).…”

Section: Discussionmentioning

confidence: 99%

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Mucosal healing with methotrexate in Crohn’s disease: a prospective comparative study with azathioprine and infliximab

Laharie

Reffet

Belleannée

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mucosal healing with methotrexate in Crohn’s disease: a prospective comparative study with azathioprine and infliximab

Laharie

Reffet

Belleannée

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

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“…A rare form of natural killer cell, hepatosplenic lymphoma has recently been described associated with azathioprine therapy for CD either alone (222) or in combination with in iximab (223,224) . Weekly methotrexate at a dose of 15 mg, intramuscularly, has also been demonstrated to maintain methotrexate-induced remissions (225) , but optimal dosing has not been established (15,17,226,227) .…”

Section: Maintenance Therapymentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

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“…Their conclusion that MTX was not better than placebo in active Crohn's was based only on the inclusion of Feagan's positive trial (25 mg/wk im MTX) and the negative orally administered MTX (12.5 mg/wk po) Oren trial. The Cochrane collaboration AZA and had already been treated with MTX for period of at least 6 mo were followed for an additional 18 mo [21] . Out of 49 patients, 42 had previously failed AZA (85%).…”

Section: Induction Of Remission In Steroid Dependent Crohn's Disease?mentioning

confidence: 99%

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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Methotrexate in Crohn's Disease: Long-Term Efficacy and Toxicity

Abstract: This study suggests a long-term benefit of maintenance treatment with methotrexate in patients with chronically active Crohn's disease, with side effects that are usually only moderate.

Cited by 87 publications

References 14 publications

Mucosal healing with methotrexate in Crohn’s disease: a prospective comparative study with azathioprine and infliximab

Mucosal healing with methotrexate in Crohn’s disease: a prospective comparative study with azathioprine and infliximab

Management of Crohn's Disease in Adults

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

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