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Continuous Fluorescence-Based Endonuclease-Coupled DNA Methylation Assay to Screen for DNA Methyltransferase Inhibitors

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Methotrexate: underused and ignored?

Hans H Herfarth¹, Millie D Long, Kim L Isaacs

¹Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC 27599, USA. hherf @ med.unc.edu

Digestive Diseases (Basel, Switzerland)

|January 9, 2013

Summary

This summary is machine-generated.

Methotrexate is effective for Crohn's disease, but its use is surprisingly low. This review explores reasons for this underutilization in inflammatory bowel disease management.

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Area of Science:

Gastroenterology
Pharmacology
Immunology

Background:

Methotrexate is a proven treatment for active, steroid-dependent Crohn's disease.
Despite established efficacy, clinical use of methotrexate for Crohn's disease appears limited.
International medication utilization data highlight a discrepancy between methotrexate's therapeutic potential and its practical application.

Purpose of the Study:

To investigate the reasons behind the underuse of methotrexate in patients with inflammatory bowel diseases, specifically Crohn's disease.
To identify barriers to methotrexate prescription and utilization in routine clinical practice.
To provide insights for improving methotrexate's role in managing Crohn's disease.

Main Methods:

Systematic literature review of studies on methotrexate use in inflammatory bowel disease.
Analysis of medication utilization data and prescribing trends.
Review of clinical guidelines and expert opinions regarding methotrexate in Crohn's disease.

Main Results:

Potential reasons for underuse include physician-related factors (e.g., concerns about toxicity, lack of familiarity), patient-related factors (e.g., side effects, adherence issues), and system-level factors (e.g., availability of alternative therapies).
Specific data on the extent of underuse and detailed reasons vary across different international settings.
Lack of comprehensive data hinders a precise understanding of the problem.

Conclusions:

The underutilization of methotrexate in Crohn's disease management is a complex issue with multifactorial causes.
Addressing physician education, patient counseling, and potentially optimizing treatment protocols may enhance methotrexate's appropriate use.
Further research is needed to quantify the underuse and evaluate interventions aimed at increasing its utilization.