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Methotrexate as single therapy in Crohn's disease: is its long-term efficacy limited?

C Charpignon1, P Beau

  • 1Service d'hépatogastroentérologie et assistance nutritive, hôpital Jean-Bernard, 86021 Poitiers, France.

Gastroenterologie Clinique Et Biologique
|March 18, 2008
PubMed
Abstract

Insights

Parenteral methotrexate showed initial efficacy in steroid-dependent Crohn's disease, but long-term effectiveness was limited. Methotrexate treatment for Crohn's disease resulted in significant symptom reduction but sustained remission in less than a third of patients.

Area of Science:

  • Gastroenterology
  • Immunosuppressive Therapy
  • Inflammatory Bowel Disease Research

Background:

  • Crohn's disease (CD) is a chronic inflammatory bowel disease.
  • Steroid-dependent CD often requires advanced therapies after conventional treatments fail.
  • Thiopurines like azathioprine are common first-line immunosuppressants for CD.

Purpose of the Study:

  • To evaluate the efficacy and patient tolerance of parenteral methotrexate (MTX) in steroid-dependent Crohn's disease.
  • To assess MTX as a maintenance therapy after an initial induction period.
  • To determine remission rates and adverse events associated with MTX in this patient population.

Main Methods:

  • A study included 35 patients with steroid-dependent CD who failed azathioprine.
  • Patients received parenteral methotrexate at 25mg/week for three months, followed by 15-25mg/week maintenance.
  • Clinical remission was defined by Harvey-Bradshaw index ≤4 and steroid withdrawal.

Main Results:

  • Methotrexate significantly reduced the Harvey-Bradshaw index, C-reactive protein (CRP), and prednisone dose after three months.
  • Clinical remission rates were 50% at three months, decreasing to 28% at one and two years.
  • Six patients (17%) discontinued methotrexate due to adverse events.

Conclusions:

  • Parenteral methotrexate demonstrates initial efficacy in steroid-dependent Crohn's disease refractory to thiopurines.
  • Long-term effectiveness of methotrexate for Crohn's disease is limited, with sustained remission in less than one-third of patients.
  • Methotrexate is a potential option but requires careful monitoring for adverse events and long-term efficacy assessment.

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