Methotrexate for maintenance of remission in Crohn's disease

Patel, Vishal; MacDonald, John K; McDonald, John W.D.; Chande, Nilesh

doi:10.1002/14651858.cd006884.pub2

Cited by 47 publications

(47 citation statements)

References 17 publications

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“…The success of methotrexate in induction and maintenance of remission in Crohn's disease has sparked interest in its potential use in ulcerative colitis. [112][113][114][115] A recent Cochrane review concluded that induction of remission with methotrexate is not supported by currently published literature, predominantly owing to insufficient data. 116 Retrospective data evaluating methotrexate maintenance therapy has yielded conflicting results.…”

Section: Methotrexatementioning

confidence: 99%

Review article: the practical management of acute severe ulcerative colitis

Seah

Cruz

2016

Aliment Pharmacol Ther

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Review: practical management of acute severe ulcerative colitis excluded if patients had a subsequent diagnosis of Crohn's disease or indeterminate colitis. PREDICTING DISEASE COURSE AND REQUIREMENT FOR SALVAGE THERAPYOptimal management of ASUC relies on timely and repeated evaluation of disease response to therapy, in order to improve clinical outcomes. One of the major challenges faced by clinicians is the absence of a widely accepted management and monitoring protocol. 11,12 In particular, three key stages of assessment in the acute setting have been investigated in the literature: (i) on admission, (ii) after initiation of steroid therapy and (iii) after initiation of salvage therapy. More recently, studies have also focussed on long-term outcomes; however, further prospective studies in this area are required. Steroid therapy

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Section: Methotrexatementioning

confidence: 99%

Review article: the practical management of acute severe ulcerative colitis

Seah

Cruz

2016

Aliment Pharmacol Ther

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“…14 However, all of them recovered after proper treatment after MTX withdrawl, which is consistent with previous results that such adverse events were generally mild in nature. 15 In conclusion, MTX at a dose of 15 mg/week or 20 mg/week i.m. is safe and effective and it may serve as an alternative immunosuppressive treatment for patients who are intolerant of thiopurine.…”

Section: Discussionmentioning

confidence: 85%

“…MTX at 25 mg weekly for induction of remission and 15 mg/week for maintenance of remission has been demonstrated. 14,15 However, neither of these Cochrane reviews included Asian studies because of the scant data. Feagan et al showed a 65% remission rate at week 40 with i.m.…”

Section: Discussionmentioning

confidence: 99%

A single‐center experience with methotrexate in the treatment of Chinese Crohn’s disease patients

Wang

Qiao

Zou

et al. 2018

J of Digest Diseases

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Objective Methotrexate (MTX) can be used as an alternative for patients with Crohn’s disease (CD) who are intolerant of thiopurine. This retrospective study aimed to provide some clues about MTX treatment in Chinese patients with CD. Methods Medical records of 27 adult patients with CD who were treated with MTX between 2012 and 2017 at Renji Hospital were reviewed. MTX was administered at 15 mg or 20 mg intramuscularly once per week. The remission and response rates and adverse reactions of MTX were recorded and analyzed. Results Thirteen (48.1%) of the patients achieved remission for more than 12 months, whereas four (14.8%) responded clinically. Eight (29.6%) patients discontinued MTX due to adverse events. The mean age of those who maintained remission was significantly younger than that of those who did not ([35.62 ± 10.99] years vs. [45.43 ± 11.93] years, P < 0.05). The pretreatment C‐reactive protein (CRP) level was higher in the group who maintained remission than that in those who did not ([17.20 ± 17.26] mg/L vs. [6.98 ± 5.66] mg/L, P < 0.05). Conclusions MTX is effective and relatively safe for patients at doses of 15 mg/week or 20 mg/week and may be an alternative therapy for patients who are intolerant of thiopurine. Elderly patients with CD and patients with normal pretreatment CRP level may have a reduced response to MTX.

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“…Current conventional options for pharmacological maintenance of medically achieved CD remission, for which there is a strong evidence base, include thiopurines (e.g. azathioprine and mercaptopurine) [2], methotrexate [3] and anti-TNF-α (infliximab and adalimumab in the UK, and in some other countries also certolizumab) [4]. In contrast, in some patients with ileal CD of limited extent, surgery may be the best option for remission maintenance, but to date there are no controlled data comparing long-term outcome in such patients treated with resection or, for example, azathioprine.…”

Section: Aims Of Options For and Limitations Of Maintenance Therapy mentioning

confidence: 99%

Are Maintenance Strategies Underused in Crohn's Disease?

Rampton

2014

Dig Dis

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A key aim in the management of Crohn's disease is to maintain disease remission, whether this has been achieved by medical or surgical treatment. The reasons for doing this are to maintain quality of life, to avoid steroid dependence and to maintain mucosal healing with a view to preventing relapse, hospital admission and surgery, and improving disease natural history. Options for remission maintenance include smoking cessation, thiopurines, methotrexate, anti-TNF-α drugs and surgery. Evidence suggests that in some places now, and in most places in the past, too few patients are/were appropriately treated when in remission, and, in many instances, treatment regimens are/were insufficiently tailored to the patient's individual phenotype, prognosis and/or genotype.

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Methotrexate for maintenance of remission in Crohn's disease

Abstract: Intramuscular methotrexate at a dose of 15 mg/week is safe and effective for maintenance of remission in Crohn's disease. Oral methotrexate (12.5 to 15 mg/week) does not appear to be effective for maintenance of remission in Crohn's disease.

Cited by 47 publications

References 17 publications

Review article: the practical management of acute severe ulcerative colitis

Review article: the practical management of acute severe ulcerative colitis

A single‐center experience with methotrexate in the treatment of Chinese Crohn’s disease patients

Are Maintenance Strategies Underused in Crohn's Disease?

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