European experience with methotrexate treatment in Crohn's disease: a multicenter retrospective analysis

Uri Kopylov, Konstantinos H Katsanos, Christien Janneke van der Woude, Konstantinos Karmiris, Vicent Hernandez, Selwyn Odes, Konstantinos Papamichael, Ioannis E Koutroubakis, Daniela Bojic, Ioannis Kaimakliotis, Gionata Fiorino, Neofytos Papageorgiou, Juan R Pineda, Konstantina Strongili, Luciano Sanroman, Gerassimos J Mantzaris, Njegica Jojic, Gregorios Paspatis, Dimitrios K Christodoulou, Shomron Ben-HorinEpameinondas V Tsianos

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: 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.

PATIENTS AND 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.

CONCLUSION: 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.

Original languageEnglish
Pages (from-to)802-6
Number of pages5
JournalEuropean Journal of Gastroenterology and Hepatology
Volume28
Issue number7
DOIs
Publication statusPublished - Jul 2016

Fingerprint

Methotrexate
Crohn Disease
Steroids
Therapeutics
Recurrence
Referral and Consultation
Maintenance
Survival
Cohort Studies
Tumor Necrosis Factor-alpha
Demography

Keywords

  • Adult
  • Crohn Disease
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Glucocorticoids
  • Humans
  • Immunosuppressive Agents
  • Kaplan-Meier Estimate
  • Male
  • Methotrexate
  • Middle Aged
  • Remission Induction
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult
  • Journal Article
  • Multicenter Study

Cite this

Kopylov, U., Katsanos, K. H., van der Woude, C. J., Karmiris, K., Hernandez, V., Odes, S., ... Tsianos, E. V. (2016). European experience with methotrexate treatment in Crohn's disease: a multicenter retrospective analysis. European Journal of Gastroenterology and Hepatology, 28(7), 802-6. https://doi.org/10.1097/MEG.0000000000000609

European experience with methotrexate treatment in Crohn's disease : a multicenter retrospective analysis. / Kopylov, Uri; Katsanos, Konstantinos H; van der Woude, Christien Janneke; Karmiris, Konstantinos; Hernandez, Vicent; Odes, Selwyn; Papamichael, Konstantinos; Koutroubakis, Ioannis E; Bojic, Daniela; Kaimakliotis, Ioannis; Fiorino, Gionata; Papageorgiou, Neofytos; Pineda, Juan R; Strongili, Konstantina; Sanroman, Luciano; Mantzaris, Gerassimos J; Jojic, Njegica; Paspatis, Gregorios; Christodoulou, Dimitrios K; Ben-Horin, Shomron; Tsianos, Epameinondas V.

In: European Journal of Gastroenterology and Hepatology, Vol. 28, No. 7, 07.2016, p. 802-6.

Research output: Contribution to journalArticle

Kopylov, U, Katsanos, KH, van der Woude, CJ, Karmiris, K, Hernandez, V, Odes, S, Papamichael, K, Koutroubakis, IE, Bojic, D, Kaimakliotis, I, Fiorino, G, Papageorgiou, N, Pineda, JR, Strongili, K, Sanroman, L, Mantzaris, GJ, Jojic, N, Paspatis, G, Christodoulou, DK, Ben-Horin, S & Tsianos, EV 2016, 'European experience with methotrexate treatment in Crohn's disease: a multicenter retrospective analysis', European Journal of Gastroenterology and Hepatology, vol. 28, no. 7, pp. 802-6. https://doi.org/10.1097/MEG.0000000000000609
Kopylov, Uri ; Katsanos, Konstantinos H ; van der Woude, Christien Janneke ; Karmiris, Konstantinos ; Hernandez, Vicent ; Odes, Selwyn ; Papamichael, Konstantinos ; Koutroubakis, Ioannis E ; Bojic, Daniela ; Kaimakliotis, Ioannis ; Fiorino, Gionata ; Papageorgiou, Neofytos ; Pineda, Juan R ; Strongili, Konstantina ; Sanroman, Luciano ; Mantzaris, Gerassimos J ; Jojic, Njegica ; Paspatis, Gregorios ; Christodoulou, Dimitrios K ; Ben-Horin, Shomron ; Tsianos, Epameinondas V. / European experience with methotrexate treatment in Crohn's disease : a multicenter retrospective analysis. In: European Journal of Gastroenterology and Hepatology. 2016 ; Vol. 28, No. 7. pp. 802-6.
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T1 - European experience with methotrexate treatment in Crohn's disease

T2 - a multicenter retrospective analysis

AU - Kopylov, Uri

AU - Katsanos, Konstantinos H

AU - van der Woude, Christien Janneke

AU - Karmiris, Konstantinos

AU - Hernandez, Vicent

AU - Odes, Selwyn

AU - Papamichael, Konstantinos

AU - Koutroubakis, Ioannis E

AU - Bojic, Daniela

AU - Kaimakliotis, Ioannis

AU - Fiorino, Gionata

AU - Papageorgiou, Neofytos

AU - Pineda, Juan R

AU - Strongili, Konstantina

AU - Sanroman, Luciano

AU - Mantzaris, Gerassimos J

AU - Jojic, Njegica

AU - Paspatis, Gregorios

AU - Christodoulou, Dimitrios K

AU - Ben-Horin, Shomron

AU - Tsianos, Epameinondas V

PY - 2016/7

Y1 - 2016/7

N2 - INTRODUCTION: 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.PATIENTS AND 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.CONCLUSION: 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.

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KW - Crohn Disease

KW - Drug Administration Schedule

KW - Drug Therapy, Combination

KW - Female

KW - Glucocorticoids

KW - Humans

KW - Immunosuppressive Agents

KW - Kaplan-Meier Estimate

KW - Male

KW - Methotrexate

KW - Middle Aged

KW - Remission Induction

KW - Retrospective Studies

KW - Treatment Outcome

KW - Young Adult

KW - Journal Article

KW - Multicenter Study

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DO - 10.1097/MEG.0000000000000609

M3 - Article

C2 - 26894634

VL - 28

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JO - European Journal of Gastroenterology and Hepatology

JF - European Journal of Gastroenterology and Hepatology

SN - 0954-691X

IS - 7

ER -