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Efficacy of parenteral methotrexate in refractory Crohn’s disease
Author(s) -
Chong R. Y.,
Hanauer S. B.,
Cohen R. D.
Publication year - 2001
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2001.00908.x
Subject(s) - medicine , methotrexate , discontinuation , refractory (planetary science) , tolerability , gastroenterology , prednisone , crohn's disease , parenteral nutrition , surgery , dosing , chemotherapy , adverse effect , disease , physics , astrobiology
Background: Methotrexate is steroid‐sparing in short‐term trials for refractory Crohn’s disease. This study assesses the impact of dosing and administration on the long‐term utility of methotrexate in Crohn’s disease. Methods: The efficacy and tolerability of methotrexate were assessed in all refractory Crohn’s disease patients treated at the University of Chicago from 1 September 1989 to 6 June 1997. Results: Seventy‐six patients were identified: 43% male, mean age 35 years, mean Crohn’s disease duration 9.5 years. Mean methotrexate duration was 55 weeks; mean dose was 20 mg/week. Drug administration was parenteral (78%), oral (13%), or combination (8%). Improvement occurred in 63% after a mean of 9 weeks, for a mean duration of 65 weeks. Remission occurred in 37% after a mean of 22 weeks, for a mean duration of 59 weeks. Improvement and remission were highest with parenteral therapy, but dose‐independent. Parenteral therapy maintained remission in 46%. Improvement ( P =0.05) and remission ( P =0.01) were more likely for patients under 40. Improvement rates were higher with concurrent steroids ( P =0.02) or antibiotics ( P =0.01). Side‐effects occurred in 46%, resulting in discontinuation in 18%. Prednisone was decreased in 78%, and stopped in 40%. Conclusions: Long‐term therapy with methotrexate in Crohn’s disease is safe, effective, steroid‐sparing, and most efficacious in younger patients and when given parenterally.