Methotrexate in patients with Crohn's disease after 6-mercaptopurine

Mack, David R.; Young, R L; Kaufman, Stuart S.; Ramey, Louise; Vanderhoof, Jon A.

doi:10.1016/s0022-3476(98)70313-0

Cited by 82 publications

(59 citation statements)

References 26 publications

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“…Further, the combination of high-dose MTX with intravenous mercaptopurine is superior to low-dose MTX with mercaptopurine [61][62][63], but it remains equivocal that high-dose MTX produces greater enhancement of thiopurine intracellular accumulation compared with low-dose MTX [22,64]. Mack et al [65] found that low-dose, weekly and subcutaneous MTX administration can induce remission in some pediatric patients with Crohn's disease who fail to adequately respond to other immunomodulator medications. Poor compliance of MTX and 6-MP treatment in childhood acute lymphoblastic leukaemia is associated with the risk of relapse [66][67][68][69][70].…”

Section: Discussionmentioning

confidence: 99%

The effect of active hexose correlated compound in modulating cytosine arabinoside-induced hair loss, and 6-mercaptopurine- and methotrexate-induced liver injury in rodents

Sun

Wakame

Sato

et al. 2009

Cancer Epidemiology

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Section: Discussionmentioning

confidence: 99%

The effect of active hexose correlated compound in modulating cytosine arabinoside-induced hair loss, and 6-mercaptopurine- and methotrexate-induced liver injury in rodents

Sun

Wakame

Sato

et al. 2009

Cancer Epidemiology

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“…Long-term lowdose weekly SQ MTX has been used successfully in pediatric patients with CD. 22 However, the efficacy of SQ MTX in CD has not been demonstrated in controlled trials.…”

Section: Why Use Oral Methotrexate?mentioning

confidence: 99%

Low-Dose Oral Methotrexate for Maintaining Crohn??s Disease Remission

Sun¹,

Das²

2005

Journal of Clinical Gastroenterology

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Methotrexate has been considered a second-line immunomodulating therapy, behind azathioprine (AZA) or its metabolite 6-mercaptopurine (6-MP), for the treatment of Crohn's disease (CD). Approximately 27% to 50% of patients with refractory CD are intolerant or resistant to AZA or 6-MP. Two well-designed randomized double-blind placebo-controlled trials have demonstrated that low-dose methotrexate (<25 mg/wk), given intramuscularly (IM), is effective in inducing and maintaining remission in CD. In clinical practice, IM injection involves an inconvenience for patients and higher costs. Furthermore, frequent IM injections increase the risk of complications such as peripheral nerve injury, local irritation, pain, bleeding, fibrosis, abscess formation, gangrene, and contractures. Alternatively, subcutaneous (SQ) injection has been advocated because it has been shown to have similar pharmacokinetics to IM injection. However, because of a recent and ongoing national shortage of parenteral methotrexate, patients who were receiving IM methotrexate had to switch to the oral form until the parenteral formulation becomes available. Oral methotrexate has been used with great success in treatment of rheumatoid arthritis and psoriasis for the past 50 years. However, the data on the usage of low-dose oral methotrexate in maintaining CD remission are scanty and controversial. The purpose of this article is to review the mechanism of action, absorption, and the objective evidence in supporting the use of oral methotrexate in maintaining CD remission.

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“…[6][7][8][9][10] In addition, low-dose MTX has been employed for a long time as part of the prophylaxis for aGVHD after HSCT. [11][12][13][14] On the other hand, MTX had also been used as a part of a combined regimen for the treatment of acute and chronic GVHD, however, there are a few published data or prospective trials to evaluate the feasibility of MTX in the treatment of GVHD.…”

Section: Introductionmentioning

confidence: 99%

Low-dose MTX for the treatment of acute and chronic graft-versus-host disease in children

Inagaki

Nagatoshi

Hatano

et al. 2007

Bone Marrow Transplant

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We report the results of a retrospective analysis in 27 pediatric patients who received low-dose MTX as the second-line treatment for steroid-refractory or -dependent acute and chronic GVHD. Between July 2000 and May 2006, 10 patients with aGVHD and 17 with cGVHD were treated with MTX at a dose of 3-10 mg/m 2 weekly. Seven of ten patients (70%) with aGVHD responded well to MTX, thus resulting in the achievement of either a complete response (CR) or a partial response (PR). The dose of prednisone could be reduced to equal to or lower than 1 mg/kg in the responding patients at the end of MTX therapy. The median number of MTX administrations was five (range, 1-7). Ten (58.8%) of seventeen patients with cGVHD achieved CR or PR. The dose of prednisone could be reduced to lower than 0.4 mg/kg in 16 of 17 patients and seven patients could discontinue prednisone. The median duration of MTX administration was 18 months (range, 1-68). The toxicities of grade III to IV occurred in only six patients presenting cytopenias or elevated levels of serum transaminases. Low-dose MTX was tolerable and effective for the steroid-refractory or -dependent GVHD in reducing the dose of steroid without increasing the risk of opportunistic infection.

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Methotrexate in patients with Crohn's disease after 6-mercaptopurine

Cited by 82 publications

References 26 publications

The effect of active hexose correlated compound in modulating cytosine arabinoside-induced hair loss, and 6-mercaptopurine- and methotrexate-induced liver injury in rodents

The effect of active hexose correlated compound in modulating cytosine arabinoside-induced hair loss, and 6-mercaptopurine- and methotrexate-induced liver injury in rodents

Low-Dose Oral Methotrexate for Maintaining Crohn??s Disease Remission

Low-dose MTX for the treatment of acute and chronic graft-versus-host disease in children

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