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The efficacy of methotrexate for maintaining remission in inflammatory bowel disease
Author(s) -
Fraser A. G.,
Morton D.,
McGovern D.,
Travis S.,
Jewell D. P.
Publication year - 2002
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.1365-2036.2002.01227.x
Subject(s) - medicine , ulcerative colitis , methotrexate , azathioprine , inflammatory bowel disease , gastroenterology , maintenance therapy , crohn's disease , mercaptopurine , surgery , retrospective cohort study , disease , chemotherapy
Background: The management of patients with inflammatory bowel disease who are resistant to or intolerant of azathioprine remains a challenge. Low‐dose methotrexate has been shown to be effective in inducing remission in Crohn's disease. Aim: This review was conducted because there are limited long‐term follow‐up data during and after stopping treatment. There are also limited data on the use of methotrexate in ulcerative colitis. Methods: The study was a retrospective review of clinical notes. Remission was defined as minimal bowel symptoms without the need for oral steroids for 3 months. Relapse was defined as bowel symptoms that required steroid treatment or surgery. Results: Seventy patients were reviewed; 48 had Crohn's disease and 22 had ulcerative colitis. The mean duration of treatment was 17.1 months; the mean maintenance dose was 20 mg weekly. Remission was achieved in 34 of 55 patients who completed more than 3 months of treatment (62%). Life‐table analysis showed that the chances of remaining in remission at 12, 24 and 36 months (if treatment was continued) were 90%, 73% and 51%, respectively. The chances of remaining in remission after stopping treatment at 6, 12 and 18 months were 42%, 21% and 16%, respectively. The dose of methotrexate (mg/kg) was associated with the induction of remission ( P =0.02). Treatment was equally effective for Crohn's disease and ulcerative colitis. Conclusions: Maintenance methotrexate treatment gives acceptable remission rates for treatment periods up to 3 years. After stopping treatment, relapse is frequent and occurs early (usually within 1 year).