A recent study (H Hansfarth et al. Gastroenterol 2018; 155: 1098-1108) examined the use of methotrexate for ulcerative colitis (UC). The authors performed a 48-week trial (MERIT-UC trial) with 179 patients with a mean age of 42 years in the induction period. In those who improved during induction, methotrexate was continued in 44 patients and compared to 40 patients who received placebo; this was a double-blind, placebo-controlled trial.
- During induction which included 16 weeks with methotrexate at 25 mg per week SC and a 12-week steroid taper, 51% had achieved a response.
- During maintenance, 60% of patients receiving placebo and 66% of patients receiving methotrexate had a relapse of UC. At 48 weeks, 30% in the placebo group and 27% in the methotrexate group were in steroid-free clinical remission.
- No new safety signals were evident with methotrexate.
The associated editorial by Dulai (pg 967-69) which reviewed this study and a prior study (METEOR) comes to the conclusion that: “there is likely no place for methotrexate monotherapy in UC.”
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