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Methotrexate in Crohn's disease: long-term efficacy and toxicity
M Lémann1, T Zenjari, Y Bouhnik
1Service d'Hépato-Gastroentérologie, Hôpital Saint-Louis, Paris, France.
The American Journal of Gastroenterology
|August 5, 2000
Summary
Weekly low-dose methotrexate offers long-term benefits for Crohn's disease patients, maintaining remission in most. While side effects occurred, they were generally moderate, indicating methotrexate's potential as a sustained therapy.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Crohn's disease is a chronic inflammatory condition.
- Methotrexate, an antimetabolite, shows short-term efficacy in Crohn's disease.
- Long-term data on methotrexate's efficacy and safety in Crohn's disease are limited.
Purpose of the Study:
- To assess the long-term efficacy and safety of weekly low-dose methotrexate in patients with chronically active Crohn's disease.
- To evaluate remission rates and relapse probabilities.
- To document adverse reactions and liver biopsy findings.
Main Methods:
- A total of 49 patients with Crohn's disease treated with methotrexate for at least 6 months were studied.
- Patients had prior steroid or azathioprine treatment failures or intolerance.
- Clinical remission was defined as a Harvey-Bradshaw index of <4.
Main Results:
- 41 out of 49 patients achieved complete clinical remission, maintained on methotrexate for a median of 18 months.
- Probabilities of relapse were 29% at 1 year, 41% at 2 years, and 48% at 3 years.
- Adverse reactions led to discontinuation in 5 patients; liver biopsies revealed mild abnormalities in some.
Conclusions:
- Long-term maintenance treatment with methotrexate provides sustained clinical benefit for Crohn's disease patients.
- Methotrexate is generally well-tolerated, with mostly moderate side effects.
- The study supports methotrexate as a valuable option for managing chronic Crohn's disease.
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