Methotrexate as single therapy in Crohn's disease: is its long-term efficacy limited?
OBJECTIVE
To determine the efficacy and patient tolerance of parenteral methotrexate in the treatment of Crohn's disease at a dose of 25mg per week for three months, then at 15-25mg per week as maintenance therapy.


METHODS
Thirty-five patients (27 women, eight men; mean age 36 years) with steroid-dependent Crohn's disease were included in the study after failure of azathioprine in 34 cases. Clinical remission was defined as a Harvey-Bradshaw disease-activity index less than or equal to 4 and complete weaning from steroids.


RESULTS
At the end of the three-month induction treatment, the Harvey-Bradshaw index decreased significantly (4.6+/-2.9 versus 9.4+/-5.2; P=0.0001), as did serum CRP (24+/-27 versus 43+/-45 mg/L; P=0.01) and prednisone dose (5.63+/-7.3 versus 21.1+/-18.7 mg/L; P=0.00001). The mean maintenance dose of methotrexate was 20.3+/-3.8 mg per week. The rate of clinical remission was 50% at three months and 28% at one year and two years. Nine patients had an adverse event attributed to methotrexate that led to drug withdrawal in six cases (17%).


CONCLUSIONS
Our findings suggest that, for steroid-dependent Crohn's disease which has failed to respond to thiopurines, long-term methotrexate remains effective in fewer than one in three patients.
Charpignon
C
C
Service d'hépatogastroentérologie et assistance nutritive, hôpital Jean-Bernard, 86021 Poitiers, France.
Beau
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D003424:Crohn Disease / Q000145:classification / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012074:Remission Induction; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D002097:C-Reactive Protein; D011241:Prednisone; D008727:Methotrexate