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Switching from Thiopurines to Methotrexate

June 14, 2013 6:23 am

Data regarding methotrexate treatment for Crohn’s disease (CD) is limited.  A fairly large retrospective study provides a better idea about its effectiveness over a five-year period (Clin Gastroenterol Hepatol 2013; 11: 667-72).

In total 174 consecutive CD patients (age 35 ±12 y) from 3 hospitals were analyzed.  All of these patients received methotrexate (MTX) after thiopurine therapy. 23% had not responded to an anti-TNF agent.  Most of the patients who had failed thiopurine treatment had an intolerance to thiopurine rather than loss of clinical response.  Data on patient characteristics including smoking status, disease behavior/location, previous treatments, and indication for MTX are detailed in Table 2.  Interestingly, 113 patients were female.  The authors noted that 90% of their patients received MTX parenterally.

Key findings:

• Patients with sustained clinical benefits from methotrexate monotherapy:  98 (86%) at 6 months, 50 (63%) at 12 months, 27 (47%) at 24 months, and 3 (20%) at 60 months.
• 45 (26%) discontinue methotrexate due to intolerance, mostly within the first 6 months.  However, adverse effects were generally mild.  Only one patient required hospital admission for an infection (cytomegalovirus).

There are many limitations of this retrospective study.  Nevertheless, a significant portion of patients derived clinical benefit for at least 2 years.

Related blog posts:

• Adding Methotrexate to anti-TNF therapy | gutsandgrowth
• Methotrexate and liver toxicity | gutsandgrowth

Posted by gutsandgrowth

Categories: Pediatric Gastroenterology Intestinal Disorder

Tags: Crohn's disease, Methotrexate, thiopurine

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3 Responses to “Switching from Thiopurines to Methotrexate”

1. […] Switching from Thiopurines to Methotrexate | gutsandgrowth […]

   By AGA Guidelines for the Use of Thiopurines and Anti-TNF Agents for Crohn’s | gutsandgrowth on December 2, 2013 at 7:04 am

2. […] Switching from Thiopurines to Methotrexate | gutsandgrowth […]

   By Teaching an Old Drug New Tricks | gutsandgrowth on February 10, 2014 at 7:09 am

3. […] Switching from Thiopurines to Methotrexate | gutsandgrowth […]

   By Methotrexate –First Choice Immunomodulator? | gutsandgrowth on September 3, 2014 at 7:00 am

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