TY - JOUR
T1 - The use of methotrexate for treatment of inflammatory bowel disease in clinical practice
AU - Saibeni, Simone
AU - Bollani, Simona
AU - Losco, Alessandra
AU - Michielan, Andrea
AU - Sostegni, Raffaello
AU - Devani, Massimo
AU - Lupinacci, Guido
AU - Pirola, Lorena
AU - Cucino, Claudia
AU - Meucci, Gianmichele
AU - Basilisco, Guido
AU - D'Incà, Renata
AU - Bruno, Savino
PY - 2012/2
Y1 - 2012/2
N2 - Background: Methotrexate is considered a treatment for Crohn's disease, whilst few data in ulcerative colitis are available. Aim: 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.
AB - Background: Methotrexate is considered a treatment for Crohn's disease, whilst few data in ulcerative colitis are available. Aim: 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.
KW - Crohn's disease
KW - Methotrexate
KW - Therapy
KW - Ulcerative colitis
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U2 - 10.1016/j.dld.2011.09.015
DO - 10.1016/j.dld.2011.09.015
M3 - Article
C2 - 22051323
AN - SCOPUS:84855735860
VL - 44
SP - 123
EP - 127
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
SN - 1590-8658
IS - 2
ER -