title: European experience with methotrexate treatment in Crohn's disease: a multicenter retrospective analysis.
abstract: BACKGROUND
  Methotrexate (MTX) has been utilized for the treatment of Crohn's disease (CD) for decades. Nevertheless, current data provide equivocal evidence on the efficacy of MTX in CD.The aims of this study were to describe the efficacy of MTX for maintenance of remission in CD and to identify the factors associated with the probability of steroid-free clinical remission in a multicenter European referral center cohort.
  
  
  METHODS
  This was a retrospective cohort analysis. Consecutive patients treated with MTX for CD were included from 11 referral centers. Patients receiving concomitant treatment with tumor necrosis factor inhibitors or thiopurines were excluded. The main outcome was steroid-free clinical remission; the secondary outcomes included the rate of complications leading to MTX discontinuation and duration of relapse-free survival in patients achieving the main outcome.
  
  
  RESULTS
  Between July 1992 and January 2012, 118 patients were identified for inclusion. MTX administration route was oral for induction in 31.4% and for maintenance in 49.1% of the patients. Steroid-free remission was achieved in 44/118 (37.2%) patients and was maintained relapse free by 28/44 (63.6%) for a median of 12 (3.5-18.5) months. At least one adverse effect was reported by 28.9% of the patients. No clinical or demographic factors were associated with either likelihood of achieving a clinical response or duration of relapse-free survival.
  
  
  CONCLUSIONS
  MTX treatment induced steroid-free clinical remission in over a third of CD patients and maintained it for a year in almost two-thirds of the responders. MTX should be considered a viable therapeutic option in CD patients refractory to other therapies.
authors.affiliation: aDepartment of Gastroenterology, Sheba Medical Center, Ramat Gan bSackler Medical School, Tel-Aviv University, Tel-Aviv cDepartment of Gastroenterology and Hepatology, Ben-Gurion University of the Negev, Beer Sheva, Israel dDivision of Gastroenterology, University of Ioannina, Ioannina eDepartment of Gastroenterology, Venizeleio General Hospital, Heraklion fFirst Department of Gastroenterology, Evangelismos Hospital, Athens gDepartment of Gastroenterology, University Hospital Heraklion, Crete, Greece hDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands iDepartment of Gastroenterology, Instituto de Investigacion Biomedica Ourense-Pontevedra-Vigo, Xerencia Xestion Integrada de Vigo, Spain jDepartment of Gastroenterology and Hepatology, Zvezdara University Clinical Centre, Zvezdara kMedical Faculty, University of Belgrade, Belgrade, Serbia lCentral IBD Clinic, Nicosia, Cyprus mIBD Center, Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy.
authors.forename: Uri
authors.initials: U
authors.lastname: Kopylov
authors.forename: Konstantinos H
authors.initials: KH
authors.lastname: Katsanos
authors.forename: Christien Janneke
authors.initials: CJ
authors.lastname: van der Woude
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Karmiris
authors.forename: Vicent
authors.initials: V
authors.lastname: Hernandez
authors.forename: Selwyn
authors.initials: S
authors.lastname: Odes
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Papamichael
authors.forename: Ioannis E
authors.initials: IE
authors.lastname: Koutroubakis
authors.forename: Daniela
authors.initials: D
authors.lastname: Bojic
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kaimakliotis
authors.forename: Gionata
authors.initials: G
authors.lastname: Fiorino
authors.forename: Neofytos
authors.initials: N
authors.lastname: Papageorgiou
authors.forename: Juan R
authors.initials: JR
authors.lastname: Pineda
authors.forename: Konstantina
authors.initials: K
authors.lastname: Strongili
authors.forename: Luciano
authors.initials: L
authors.lastname: Sanroman
authors.forename: Gerassimos J
authors.initials: GJ
authors.lastname: Mantzaris
authors.forename: Njegica
authors.initials: N
authors.lastname: Jojic
authors.forename: Gregorios
authors.initials: G
authors.lastname: Paspatis
authors.forename: Dimitrios K
authors.initials: DK
authors.lastname: Christodoulou
authors.forename: Shomron
authors.initials: S
authors.lastname: Ben-Horin
authors.forename: Epameinondas V
authors.initials: EV
authors.lastname: Tsianos
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D008727:Methotrexate