Methotrexate treatment of idiopathic granulomatous hepatitis.
OBJECTIVE
To test the efficacy and safety of low-dose oral pulse methotrexate therapy in patients with idiopathic granulomatous hepatitis who had complications of, did not respond to, or refused glucocorticoid therapy.


METHODS
Prospective case study.


METHODS
Academic medical center hospital.


METHODS
Seven patients with biopsy-proven, idiopathic granulomatous hepatitis who could not tolerate or were unresponsive to glucocorticoid therapy.


METHODS
Low-dose oral pulse methotrexate, 15 mg/wk.


METHODS
Temperature, symptoms, dose of concurrent glucocorticoids, biochemical tests of liver function, side effects of methotrexate, and assessment of liver biopsy specimens.


RESULTS
All six febrile patients became afebrile within 3 months of starting methotrexate. Fatigue and anorexia improved in all patients. Glucocorticoid therapy was successfully discontinued within 6 months of starting methotrexate in four patients receiving prednisone at entry. Liver biopsy specimens were obtained again after methotrexate therapy and showed absence of granulomas in four of four patients. The minimum effective dose of methotrexate was 0.20 mg/kg body weight per week. No serious adverse effects and no failures to respond to methotrexate therapy were noted in this group of patients. In three patients, methotrexate therapy has been successfully tapered without signs or symptoms of recurrent disease.


CONCLUSIONS
Low-dose oral pulse methotrexate was effective in treating patients with granulomatous hepatitis.
Knox
T A
TA
New England Medical Center Hospitals, Boston, Massachusetts.
Kaplan
M M
MM
Gelfand
J A
JA
Wolff
S M
SM
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D005260:Female; D006099:Granuloma / Q000188:drug therapy* / Q000209:etiology; D006505:Hepatitis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D011446:Prospective Studies
D008727:Methotrexate