Low-dose methotrexate is ineffective in primary biliary cirrhosis: long-term results of a placebo-controlled trial.
OBJECTIVE
New treatments for primary biliary cirrhosis (PBC) need to be evaluated. We conducted a single-center double-blind, randomized trial of methotrexate, 7.5 mg/wk (n = 30), vs. placebo (n = 30) for up to 6 years in PBC.


METHODS
Methods included three monthly symptom assessment and liver function tests and liver biopsy and gastroscopy at baseline, after 2 years, and after 4-6 years.


RESULTS
Patients randomized to methotrexate had, compared with patients randomized to placebo, (1) significantly lower on-treatment serum alkaline phosphatase, gamma-glutamyltransferase, immunoglobulin (Ig) M, IgG, and (after 24 months) aspartate aminotransferase and alanine aminotransferase levels (P < 0.02-0.001 by analysis of covariance to adjust for baseline differences); (2) a nonsignificant trend toward lower on-treatment pruritus scores; (3) similar on-treatment Knodell inflammatory scores but nonsignificant trends toward lower Knodell fibrosis score and less ductopenia; (4) a trend toward greater increases in serum bilirubin level and Mayo score with time (both significant after 5 years of follow-up); and (5) a 2.9-fold (95% confidence interval, 0.85-10.25-fold) increase the rate of death or liver transplantation as a result of liver disease during or after the trial (P = 0.09) in a Cox multivariate regression analysis compared with patients randomized to placebo.


CONCLUSIONS
These results do not support the clinical use of low-dose methotrexate in PBC.
Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, England, United Kingdom.
M T
MT
Hendrickse
E
E
Rigney
M H
MH
Giaffer
I
I
Soomro
D R
DR
Triger
J C
JC
Underwood
D
D
Gleeson
D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001323:Autoantibodies / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000188:drug therapy*; D016031:Liver Transplantation; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D008928:Mitochondria / Q000276:immunology
D001323:Autoantibodies; D000410:Alanine Transaminase; D001663:Bilirubin; D008727:Methotrexate