A Comparison of Methotrexate with Placebo for the Maintenance of Remission in Crohn's Disease

Feagan, Brian G.; Fedorak, Richard N.; Irvine, E. Jan; Wild, Gary; Sutherland, Lloyd R.; Steinhart, A. Hillary; Greenberg, G.R.; Koval, John J.; Wong, Cindy J.; Hopkins, Marybeth; Hanauer, Stephen B.; McDonald, John W.D.

doi:10.1056/nejm200006013422202

Cited by 665 publications

(349 citation statements)

References 32 publications

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“…Feagan demonstrated the use of MTX in Crohn's disease for maintenance of remission in a large double-blind, placebo controlled multi-center study with 76 patients in 2000 [16] . Some of these patients were enrolled from Feagan's trial for induction of remission using 25 mg im/wk MTX in 1995 and others from an open label trial of 25 mg/wk im MTX.…”

Section: Maintenance Of Steroid-free Remission In Crohn's Disease?mentioning

confidence: 99%

Use of methotrexate in inflammatory bowel disease in 2014: A User’s Guide

Swaminath¹

2014

WJGPT

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Methotrexate has been used an immunomodulator in many autoimmune diseases, including inflammatory bowel disease. However, many physicians are unfamiliar or uncomfortable with its use in the management of inflammatory bowel disease. We summarize the data for use of methotrexate in common clinical scenarios: (1) steroid dependant Crohn's disease (CD); (2) maintenance of remission in steroid free CD; (3) azathioprine failures in CD; (4) in combination therapy with Anti-TNF agents in CD; (5) decreasing antibody formation to Anti-TNF therapy in CD; (6) management of fistulizing disease in CD; and (7) as well as induction and maintenance of remission in ulcerative colitis. An easy to use algorithm is provided for the busy clinician to access and safely prescribe methotrexate for their inflammatory bowel disease patients.

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Section: Maintenance Of Steroid-free Remission In Crohn's Disease?mentioning

confidence: 99%

Use of methotrexate in inflammatory bowel disease in 2014: A User’s Guide

Swaminath¹

2014

WJGPT

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“…Intramuscular MTX (at lower doses than in active CD) has been shown to successfully maintain disease remission induced by steroids and MTX [43], but the scarce available data on long-term efficacy make this treatment only an alternative therapy in patients intolerant or refractory to thiopurines.…”

Section: Crohn’s Diseasementioning

confidence: 99%

Inflammatory Bowel Disease: Current Therapeutic Options

Domènech

2006

Digestion

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Medical management of inflammatory bowel diseases (IBD) includes two treatment strategies: induction and maintenance of remission. 5-Aminosalycilates are mostly used for mild active IBD and for maintenance treatment in ulcerative colitis (UC). Glucocorticoids remain, despite their frequent (and occasionally severe) side effects, as the mainstay for induction of remission in moderate to severe active IBD, both UC and Crohn’s disease (CD). Cyclosporine and infliximab have emerged as the main, rapid-acting, alternatives in steroid-refractory UC and CD, respectively. Thiopurines (azathioprine and 6-mercaptopurine) are the most efficient and used immunomodulators in IBD; steroid refractoriness, steroid dependency, and long-term maintenance of remission for both UC and CD are their main indications. Methotrexate and infliximab may be used in the same clinical settings as thiopurines in CD, but not in UC; however, these drugs are a second-line treatment because of safety profile and economic costs.

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“…Feagan et al [44] conducted a double-blind, placebo-controlled multicenter study of patients with chronically active Crohn’s disease who had entered remission after treatment with 25 mg of methotrexate given intramuscularly once a week. After 40 weeks, 65% of the patients receiving methotrexate were in remission in the methotrexate group as compared to 39% in the placebo group (p = 0.04).…”

Section: Treatmentmentioning

confidence: 99%

Maintenance of Remission in Crohn’s Disease

et al. 2005

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When remission of Crohn’s disease is achieved, the next goal is to maintain long-term remission. Aminosalicylates may be recommended for maintenance remission, even though the results are less consistent than those observed in ulcerative colitis. The benefit is mainly observed in the post-surgical setting and in patients with ileitis, and with a prolonged disease duration. Corticosteroids are not effective in maintaining remission and should not be used for this indication. Azathioprine and 6-mercaptopurine are effective in maintaining remission. Maintenance benefits remain significant for patients who continued with the therapy for up to 5 years. Methotrexate has also been found to be effective in maintaining remission in Crohn’s disease in patients who have responded acutely to methotrexate. Cyclosporine has not been found to be an effective maintenance agent. Mycophenolate mofetil could be considered a therapy in patients who are either allergic to azathioprine or in whom azathioprine failed to induce remission. The use of infliximab may change the future approach to maintenance therapy for Crohn’s disease. Patients who responded clinically to infliximab have maintained their clinical response when receiving repeat infusions at 8-week intervals. In patients refractory to other therapies, infliximab may be effective in maintaining remission.

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A Comparison of Methotrexate with Placebo for the Maintenance of Remission in Crohn's Disease

Abstract: In patients with Crohn's disease who enter remission after treatment with methotrexate, a low dose of methotrexate maintains remission.

Cited by 665 publications

References 32 publications

Use of methotrexate in inflammatory bowel disease in 2014: A User’s Guide

Use of methotrexate in inflammatory bowel disease in 2014: A User’s Guide

Inflammatory Bowel Disease: Current Therapeutic Options

Maintenance of Remission in Crohn’s Disease

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