Maiden, L.P.; Harris, A.W.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA63
Academic Journal
Background: Methotrexate (MTX) is of proven benefit in treating and maintaining remission in active Crohn's disease. We report our experience in the use of this immunomodulatory agent over a 24 month period in those patients with refractory Crohn's disease, demonstrating its useful role in a district general hospital. Methods: MTX was offered to 13 patients (9 female) with refractory Crohn's disease. All 13 commenced treatment following the regimen reported by Feagan et al at a dose of 25mg intramuscularly (im) once a week for 16 weeks and continued at 15mg im once a week thereafter. Corticosteroids and aminosalicylates were the only concurrent treatment. Efficacy was assessed by steroid withdrawal and remission rates. Adverse events were recorded at each visit. Results: Mean age was 46 years, (range 31-69). Mean length of treatment was 38 weeks, (range 5-105). Total mean dose was 700mg, (range 125mg-1735mg). 8 patients (62%) achieved clinical remission. 5 patients were unable to complete 16 weeks of treatment: 2 withdrew due to intolerance from nausea; 2 required surgery for continuing disease; 1 commenced warfarin and was thus unable to receive further intramuscular injections after achieving clinical remission at 14 weeks. Of the 6 who completed 16 weeks of treatment, 4 have continued maintenance at 15mg im weekly and 2 have discontinued treatment (1 wished to become pregnant and the other had few symptoms and wanted to discontinue). 1 patient required further treatment with corticosteroids following a clinical relapse and 1 required 4 weeks of MTX at 25mg/week to control symptoms of a relapse before returning to the maintenance dose. Adverse events reported were mucositis (1) and nausea (3). Conclusions: MTX is a well tolerated alternative treatment in refractory Crohn's disease, which is safe and practical to administer in a district general hospital. The results of our experience are in keeping with those of 2 large, double-blind, randomised trials.


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