title: Clinical experience of methotrexate in Crohn's disease: response, safety and monitoring of treatment.
abstract: BACKGROUND
  Methotrexate is an immunosuppressant used in the treatment of patients with Crohn's disease who are intolerant or refractory to azathioprine.
  
  
  OBJECTIVE
  To present clinical experience in terms of response, side effects and reason for cessation of methotrexate treatment as well as adherence to monitoring regimens.
  
  
  METHODS
  Retrospective review of case records of 37 patients taking methotrexate for Crohn's disease at the Bristol Royal Infirmary, a large UK teaching hospital. Thirty-five patients used oral methotrexate.
  
  
  RESULTS
  Response rate to methotrexate was 78% at 3 months. Adverse events were uncommon and rarely dangerous. Monitoring of treatment did not adhere to British Society of Gastroenterology guidelines.
  
  
  CONCLUSIONS
  Oral methotrexate is effective and safe in the treatment of Crohn's disease. This is in contrast to findings of previous series, which have mainly reported on intramuscular methotrexate use. Monitoring of treatment is currently inadequate and consensus should be sought for a pragmatic monitoring schedule to resolve this important governance issue.
authors.affiliation: Department of Gastroenterology, Bristol Royal Infirmary, Lower Marlborough Street, Bristol BS2 8HW, UK. richardparker@nhs.net
authors.forename: Richard
authors.initials: R
authors.lastname: Parker
authors.forename: Anindya
authors.initials: A
authors.lastname: Dixit
authors.forename: Anyinda
authors.initials: A
authors.lastname: Dixit
authors.forename: Aileen
authors.initials: A
authors.lastname: Fraser
authors.forename: Tom J
authors.initials: TJ
authors.lastname: Creed
authors.forename: Chris S
authors.initials: CS
authors.lastname: Probert
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D008727:Methotrexate