title: The use of methotrexate for treatment of inflammatory bowel disease in clinical practice.
abstract: BACKGROUND
  Methotrexate is considered a treatment for Crohn's disease, whilst few data in ulcerative colitis are available.
  
  
  OBJECTIVE
  To evaluate frequency, indications, efficacy and safety of methotrexate in inflammatory bowel disease patients.
  
  
  METHODS
  5420 case histories were reviewed.
  
  
  RESULTS
  Methotrexate was prescribed to 112 patients (2.1%; 89 Crohn's disease, 23 ulcerative colitis). It was the first-line immunosuppressive option in 32 (28.6%), it was an alternative drug due to toxicity or failure of thiopurines in 80 (71.4%). Steroid-dependence represented the main indication both when it was used as first (13/32, 40.6%) and second option (41/80, 51.2%). Efficacy was considered optimal in 39/112 (34.8%), partial in 29/112 (25.9%), absent in 22/112 (19.6%), not assessable in 22/112 (19.6%). Side effects happened in 49 out of 112 patients (43.7%) (39 Crohn's disease, 10 ulcerative colitis), leading to drug discontinuation in 38 (33.9%). The occurrence of side effects was approximately fivefold higher in patients who did not receive folic acid (14/19, 73.7%) than in those who did (35/93, 37.6%): odds ratio 4.64, 95% confidence interval 1.54-14.00; p=0.005.
  
  
  CONCLUSIONS
  The use of methotrexate appears to be negligible in clinical practice. However, our results suggest that, if appropriately used, methotrexate could be more widely administered to inflammatory bowel disease patients with complicated disease.
authors: Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy. saibo@tiscali.it
authors: Simone
authors: S
authors: Saibeni
authors: Simona
authors: S
authors: Bollani
authors: Alessandra
authors: A
authors: Losco
authors: Andrea
authors: A
authors: Michielan
authors: Raffaello
authors: R
authors: Sostegni
authors: Massimo
authors: M
authors: Devani
authors: Guido
authors: G
authors: Lupinacci
authors: Lorena
authors: L
authors: Pirola
authors: Claudia
authors: C
authors: Cucino
authors: Gianmichele
authors: G
authors: Meucci
authors: Guido
authors: G
authors: Basilisco
authors: Renata
authors: R
authors: D'Incà
authors: Savino
authors: S
authors: Bruno
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate