Efficacy of methotrexate in Crohn’s disease and ulcerative colitis patients unresponsive or intolerant to azathioprine /mercaptopurine

Wahed, Mahmood; Louis-Auguste, John; Baxter, Louisa; Limdi, J K; McCartney, Sara; Lindsay, James O.; Bloom, S

doi:10.1111/j.1365-2036.2009.04073.x

Cited by 86 publications

(63 citation statements)

References 32 publications

(38 reference statements)

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“…Methotrexate has also been used to maintain remission in patients with steroid-dependent UC who fail to respond to or who are intolerant of thiopurines, but the evidence is mainly based on uncontrolled studies with small sample sizes and heterogeneous doses [24,25] . In a recent study, clinical response to methotrexate was seen in 7 of 9 (78%) of UC patients who were refractory to thiopurines and 15 of 23 (65%) who were intolerant to thiopurines [26] . However, the data are limited and evidence is lacking to recommend methotrexate to maintain remission in UC.…”

Section: Maintenance Treatmentmentioning

confidence: 93%

Recent advances in the management of distal ulcerative colitis

Koutroubakis¹

2010

WJGPT

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The most frequent localization of ulcerative colitis (UC) is the distal colon. In treating patients with active distal UC, efficacy and targeting of the drug to the distal colon are key priorities. Oral and rectal 5-aminosalicylic acid (5-ASA) preparations represent the first line therapy of mild-to-moderate distal UC for both induction and maintenance treatment. It has been reported that many UC patients are not adherent to therapy and that noncompliant patients had a 5-fold risk of experiencing a relapse. These findings led to the introduction of oncedaily oral regimens of 5-ASA as better therapeutic options in clinical practice due to improved adherence. New formulations of mesalazine, including the multimatrix delivery system, and mesalazine granules, which allow once-daily administration, have been developed. They have been demonstrated to be efficacious in inducing and maintaining remission in mild-to-moderate distal UC in large clinical trials. However, existing data for distal UC are rather insufficient to make a comparison between new and classical 5-ASA formulations. It seems that the new formulations are at least as effective as classical oral 5-ASA formulations. Other treatment options, in the case that 5-ASA therapy is not effective, include systemic corticosteroids, thiopurines (azathioprine or 6-mercaptopurine), cyclosporine, infliximab and surgery. The combination of a prompt diagnostic workup, a correct therapeutic approach and an appropriate follow-up schedule is important in the management of patients with distal UC. This approach can shorten the duration of symptoms, induce a prolonged remission, improve patient's quality of life, and optimize the use of health resources.

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Section: Maintenance Treatmentmentioning

confidence: 93%

Recent advances in the management of distal ulcerative colitis

Koutroubakis¹

2010

WJGPT

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“…Wahed et al [22] evaluated clinical response of 99 CD patients retrospectively who were placed on MTX due to AZA intolerance or nonresponse. The study suffers from a non-homogenous doses and method of administration of MTX for induction and maintenance.…”

Section: Induction Of Remission In Steroid Dependent 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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“…leczenia, a wg niektórych autorów nawet później [1]. Niestety, u części chorych (wg niektórych zestawień nawet u 20-40%) leki te są nieskuteczne lub powodują wystąpienie działań niepożądanych (nudności, wymioty, uszkodzenie wątroby, szpiku, zapalenie trzustki) prowadzących do przerwania leczenia [2,3]. U tych chorych można rozważyć kilka terapii alternatywnych.…”

Section: Wprowadzenieunclassified

Methotrexate in the treatment of inflammatory bowel disease

Dziurkowska-Marek¹,

Marek²

2011

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StreszczenieLeczenie immunosupresyjne w nieswoistych chorobach zapalnych jelit (NChZJ) jest istotną, a często najważniejszą składo-wą terapii. Glikokortykosteroidy ze względu na działania niepożądane nie powinny być stosowane przewlekle, a poza tym u części chorych nie są skuteczne. Kolejną grupą leków immunosupresyjnych są analogi puryn (azatiopryna i 6-merkaptopuryna) -podstawowe leki u większości osób z chorobą Leśniowskiego-Crohna oraz u chorych z wrzodziejącym zapaleniem jelita grubego, z postacią steroidozależną lub steroidooporną tej choroby. U ok. 20% chorych leki te nie są jednak skuteczne, a u podobnego odsetka występują działania niepożądane prowadzące do ich odstawienia. U chorych tych zwykle rozważa się leczenie biologiczne lub chirurgiczne, rzadko bierze się pod uwagę trzecią opcję leczenia immunosupresyjnego -terapię metotreksatem. Lek ten, dość szeroko stosowany od wielu lat w ciężkich postaciach reumatoidalnego zapalenia stawów i łuszczycy, w gastroenterologii wykorzystuje się stosunkowo rzadko. W niniejszym opracowaniu omówiono mechanizmy działania, dawkowanie i bezpieczeń-stwo leku oraz przedstawiono dotychczasowe jego zastosowania u osób z NChZJ. AbstractImmunosuppressive treatment in inflammatory bowel disease (IBD) is an important and often the fundamental part of therapy. Glucocorticoids should not be used in long-term treatment because of their side effects and, otherwise, poor efficiency in a subgroup of patients. Purine analogues (azathioprine and 6-mercaptopurine) comprise another group of immunosuppressive drugs. They are the principal drugs in the majority of patients with Crohn's disease and steroid-dependent or steroid-resistant patients with ulcerative colitis. However, in about 20% of IBD patients purine analogues are ineffective and in a similar percentage of patients they are responsible for side-effects, leading to withdrawal of treatment. Biological therapy or surgery is usually considered in these patients, not commonly taking into account the third option of immunosuppressive treatment -methotrexate (MTX). This drug, widely used for many years in patients with severe rheumatoid arthritis and psoriasis, is relatively seldom used in gastroenterology. This paper discusses mechanisms of action of MTX, its dosage and safety of treatment and presents the results of its use in patients with IBD.

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Efficacy of methotrexate in Crohn’s disease and ulcerative colitis patients unresponsive or intolerant to azathioprine /mercaptopurine

Abstract: SUMMARY BackgroundDespite the wide use of azathioprine ⁄ mercaptopurine (AZA ⁄ MP) therapy in the management of both Crohn's disease (CD) and ulcerative colitis (UC), approximately 20% of patients cannot tolerate the drugs and 30% do not respond.

Cited by 86 publications

References 32 publications

Recent advances in the management of distal ulcerative colitis

Recent advances in the management of distal ulcerative colitis

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

Methotrexate in the treatment of inflammatory bowel disease

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