Efficacy of methotrexate in Crohn's disease and ulcerative colitis patients unresponsive or intolerant to azathioprine /mercaptopurine.
BACKGROUND
Despite the wide use of azathioprine/mercaptopurine (AZA/MP) therapy in the management of both Crohn's disease (CD) and ulcerative colitis (UC), approximately 20% of patients cannot tolerate the drugs and 30% do not respond.


OBJECTIVE
To examine the efficacy and safety profile of methotrexate (MTX) in patients with CD or UC who are either intolerant or non-responsive to AZA/MP.


METHODS
A total of 131 patients with IBD treated with MTX were identified. Retrospective data were obtained by case note review. Clinical response (defined as steroid withdrawal, normalization of previously raised CRP or physician's clinical assessment of improvement) was assessed at 6 months.


RESULTS
Clinical response in Crohn's disease occurred in 18 of 29 patients (62%) refractory to AZA/MP and 42 of 70 patients (60%) intolerant to AZA/MP, with no difference between the groups (P = 1.0). In UC, clinical response was seen in 7 of 9 (78%) patients refractory to AZA/MP and 15 of 23 (65%) intolerant to thiopurines. MTX was well tolerated in a majority of individuals.


CONCLUSIONS
Methotrexate appears effective in both CD and UC patients who fail to respond to or are intolerant to AZA/MP therapy.
Wahed
M
M
Department of Gastroenterology, University College London Hospitals NHS Trust, London, UK.
Louis-Auguste
J R
JR
Baxter
L M
LM
Limdi
J K
JK
McCartney
S A
SA
Lindsay
J O
JO
Bloom
S L
SL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000627:therapeutic use*; D004342:Drug Hypersensitivity; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use*; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine; D008727:Methotrexate