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News

Methotrexate monotherapy after thiopurine therapy is beneficial in Crohn's

A study in the latest Clinical Gastroenterology & Hepatology reports a sustained clinical benefit and tolerability of methotrexate monotherapy after thiopurine therapy in patients with Crohn's disease.

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Methotrexate is an immunosuppressant that is used to treat patients with Crohn's disease.

However, there are few data on the long-term effects of methotrexate maintenance therapy for these patients.

Dr Margien Seinen and colleagues reported that they assessed the sustained clinical benefits and tolerability of methotrexate monotherapy after thiopurine therapy in patients with Crohn's disease.

The research team analyzed data from 3 hospitals on 174 consecutive patients with Crohn's disease who received methotrexate monotherapy after thiopurine therapy from 2000 to 2010.

The team of doctors examined that they assessed patient characteristics, and the tolerability and sustained clinical benefits of the treatment.

Sustained clinical benefit was defined as ongoing use of methotrexate or intentional discontinuation of successful therapy before the end-of-study point.

47% received therapy or intentionally discontinued successful therapy within 2 years
Clinical Gastroenterology and Hepatology

The research team noted that the number of patients with sustained clinical benefits from methotrexate monotherapy were 98, 50, 27, and 3, at 6, 12, 24, and 60 months, respectively.

The team observed that 45 patients discontinued methotrexate because of intolerance, particularly within 6 months after therapy began.

The team of doctors reported that adverse responses generally were mild.

Only 1 patient required admission to the hospital for infection with cytomegalovirus, and no drug-related deaths were reported.
 
Intolerance of the preceding thiopurine therapy was associated with adverse events during methotrexate therapy.

Dr Seinen's team commented, "In a large cohort study of patients who received methotrexate monotherapy after thiopurine therapy for Crohn's disease, 47% continued to receive the therapy or intentionally discontinued successful therapy within 2 years, and 20% did so within 5 years."

"Long-term use of methotrexate was well tolerated and relatively safe."

Clin Gastroenterol and Hepatol 2013: 6(11): 667-672
27 June 2013

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