title: Methotrexate in ulcerative colitis: a Spanish multicentric study on clinical use and efficacy.
abstract: BACKGROUND
  Few data are available on the efficacy of methotrexate (MTX) in ulcerative colitis (UC).
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of MTX in UC patients.
  
  
  METHODS
  UC patients who had been treated with MTX were identified from the databases of 8 Spanish IBD referral hospitals. Patients were included in the study if they received MTX for steroid dependency or steroid refractoriness. Therapeutic success was defined as the absence of UC-related symptoms, complete steroid withdrawal and no requirement of rescue therapies within the first 6 months after starting MTX.
  
  
  RESULTS
  Forty patients were included, 70% treated for steroid dependency and 27% for steroid refractoriness. Thiopurines had been previously attempted in 87.5% of patients. The median dose of MTX used for induction was 25mg (IIQ 17.5-25) weekly given parenterally in 82.5% of cases. Eighty-five percent of patients were on steroids when MTX was started. Forty-five percent of patients met criteria for therapeutic success. Initial treatment failures were mainly due to inefficacy (50%) or intolerance (36%). After a median follow-up of 28 months (IQR 22-47), 38% of patients with initial therapeutic success required new steroid courses, 22% started biological therapy, and only 1 patient required colectomy. The cumulative probability of maintaining steroid-free clinical remission was 60%, 48%, and 35% at 6, 12, and 24 months after starting MTX, respectively. Eleven patients (27.5%) experienced adverse events, leading to MTX discontinuation in only 8 of them.
  
  
  CONCLUSIONS
  MTX appears to be effective to maintain clinical remission in UC, at least in the short-term, with an acceptable safety profile.
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Badalona, Spain. mmanosa.germanstrias@gencat.cat
authors.forename: Míriam
authors.initials: M
authors.lastname: Mañosa
authors.forename: Valle
authors.initials: V
authors.lastname: García
authors.forename: Luisa
authors.initials: L
authors.lastname: Castro
authors.forename: Orlando
authors.initials: O
authors.lastname: García-Bosch
authors.forename: María
authors.initials: M
authors.lastname: Chaparro
authors.forename: Manuel
authors.initials: M
authors.lastname: Barreiro-de Acosta
authors.forename: Daniel
authors.initials: D
authors.lastname: Carpio
authors.forename: Mariam
authors.initials: M
authors.lastname: Aguas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D060828:Induction Chemotherapy; D060046:Maintenance Chemotherapy; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate