title: The absorption of low-dose methotrexate in patients with inflammatory bowel disease.
abstract: BACKGROUND
  Recent clinical trials have demonstrated that methotrexate may have an important therapeutic role in the treatment of patients with inflammatory bowel disease, who are either refractory or intolerant to traditional medical therapy. The aim of this study was to evaluate the pharmacokinetics of low-dose oral methotrexate in patients with inflammatory bowel disease.
  
  
  METHODS
  Methotrexate (12.5 mg) was given orally to nine patients with inflammatory bowel disease: five with Crohn's disease, and four with ulcerative colitis, and to six patients with rheumatoid arthritis who served as a control group. Blood samples were drawn at specific intervals to evaluate methotrexate plasma levels.
  
  
  RESULTS
  Methotrexate was rapidly absorbed in all patients. Peak concentrations (Cmax) varied considerably, ranging from 0.25-0.87 micro M. The mean Cmax values were similar in all patient groups (0.59 +/- 0.12, 0.69 +/- 0.16 and 0.54 +/- 0.18 micro M, P not significant) for Crohn's disease, ulcerative colitis and rheumatoid arthritis, respectively. The mean area under curve in 120 min (AUC0-120) was also similar in all patient groups (32.9 + 11.3, 43.6 + 9.9 and 41.8 + 14.9 ng.min/mL, P not significant) for Crohn's disease, ulcerative colitis and rheumatoid arthritis, respectively. The mean time to reach Cmax, (tmax), varied between patient groups (84, 112 and 95 min, respectively, with a significant difference, P < 0.02, between the Crohn's disease and ulcerative colitis groups. A negative correlation was found between methotrexate dosage/kg and Cmax (r = -0.74) only in Crohn's disease patients but not in the other patient groups.
  
  
  CONCLUSIONS
  Orally administered methotrexate is well absorbed in patients with inflammatory bowel disease including those with severe small bowel disease or resection. If methotrexate is proven to be effective in inflammatory bowel disease, it should be administered orally.
authors.affiliation: Department of Gastroenterology, Ichilov Hospital, Tel Aviv Medical Center, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Moshkowitz
authors.forename: R
authors.initials: R
authors.lastname: Oren
authors.forename: M
authors.initials: M
authors.lastname: Tishler
authors.forename: F M
authors.initials: FM
authors.lastname: Konikoff
authors.forename: E
authors.initials: E
authors.lastname: Graff
authors.forename: S
authors.initials: S
authors.lastname: Brill
authors.forename: M
authors.initials: M
authors.lastname: Yaron
authors.forename: T
authors.initials: T
authors.lastname: Gilat
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005493:Folic Acid Antagonists / Q000493:pharmacokinetics*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000378:metabolism*; D008297:Male; D008727:Methotrexate / Q000493:pharmacokinetics*; D008875:Middle Aged; D013997:Time Factors
chemical_list: D005493:Folic Acid Antagonists; D008727:Methotrexate