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.


Related Articles

  • USE OF METHOTREXATE FOR INDUCTION OF REMISSION IN CROHN'S DISEASE.  // Archives of Disease in Childhood;Apr2003 Supplement, Vol. 88, pA15 

    Presents an abstract of the study 'Use of Methotrexate for Induction of Remission in Crohn's Disease: A Retrospective Cohort Study,' by L. Pieterse, P. Rogers, D. Hoole, P.M. Gillett and D.C. Wilson, presented at the 7th Spring Meeting of the Royal College of Paediatrics and Child Health.

  • Methotrexate for Maintaining Remission of Crohn's Disease. Kirchner, Jeffrey T. // American Family Physician;12/1/2000, Vol. 62 Issue 11, p2506 

    Presents an abstract of the study `A Comparison of Methotrexate With Placebo for the Maintenance of Remission in Crohn's Disease,' by B.G. Feagan et al., from the June 1, 2000 issue of the `New England Journal of Medicine.'

  • Pharmacokinetic profiles for oral and subcutaneous methotrexate in patients with Crohn's disease. Wilson, A. // Inflammatory Bowel Disease Monitor;2013, Vol. 13 Issue 3, p121 

    A review of the article "Pharmacokinetic profiles for oral and subcutaneous methotrexate in patients with Crohn's disease," by A. Wilson and colleagues, which appeared in the periodical "Alimentary Pharmacology & Therapeutics" in the 2013 issue is presented.

  • Methotrexate.  // Reactions Weekly;12/1/2007, Issue 1180, p28 

    The article describes the case of a 36-year-old obese woman who developed pneumonitis during treatment with methotrexate for Crohn's disease. The patient has been receiving prednisolone, weekly IM methotrexate 25mg and folic acid. She experienced progressive oral and retrosternal pain, dry cough...

  • Methotrexate effective for maintenance of remission in Crohn's disease. McAvoy, Brian R. // New Zealand Doctor;3/10/2010, p28 

    The article presents a study that examined the effectiveness of methotrexate for maintenance of remission in Crohn's disease.

  • Crohn's disease: Methotrexate can reduce prednisone requirements.  // Modern Medicine;May95, Vol. 63 Issue 5, p55 

    Presents an abstract of the article `Methotrexate for the Treatment of Crohn's Disease,' by B.G. Feagan, J. Rochon, et al published in the periodical `The New England Journal of Medicine,' dated February 2, 1995.

  • Clinical experience of methotrexate in Crohn's disease: response, safety and monitoring of treatment. Parker, Richard; Dixit, Anyinda; Fraser, Aileen; Creed, Tom J.; Probert, Chris S. // Postgraduate Medical Journal;Apr2010, Vol. 86 Issue 1014, p208 

    Background Methotrexate is an immunosuppressant used in the treatment of patients with Crohn's disease who are intolerant or refractory to azathioprine. Aim To present clinical experience in terms of response, side effects and reason for cessation of methotrexate treatment as well as adherence...

  • Dosing 6-Thioguanine in Inflammatory Bowel Disease: Expert-Based Guidelines for Daily Practice. Seinen, Margien L.; Van Asseldonk, Dirk P.; Mulder, Chris J. J.; de Boer, Nanne K. H. // Journal of Gastrointestinal & Liver Diseases; 

    Conventional thiopurines are considered to be effective and safe in the treatment of inflammatory bowel disease (IBD) patients; unfortunately more than 50% of patients discontinue thiopurine therapy, mainly due to the development of intractable adverse events. In recent years, the use of...

  • Immunomodulation does not alter histology in resected Crohn’s disease. Frizelle, F. A.; Ing, A.; Gearry, R. B.; Whitehead, M.; Faragher, I. G.; Dobbs, B. // Techniques in Coloproctology;Dec2009, Vol. 13 Issue 4, p295 

    The use of immunomodulators (Azathioprine, 6-Mercaptopurine and Methotrexate) and biological agents (Infliximab and adalimumab) for the treatment of Crohn’s disease (CD) has increased in the recent years with the aim of treating the inflammatory component of the disease and hoping to...


Read the Article


Sign out of this library

Other Topics