Methotrexate effective for maintenance of remission in Crohn's disease

January 01, 0001

Methotrexate effective for maintenance of remission in Crohn's disease

Clinical Question:How effective is methotrexate for maintenance of remission in Crohn's disease?

Bottom line: Methotrexate (15mg/week) injected intramuscularly for 40 weeks is an effective treatment (NNT* 4) for preventing relapse among patients whose disease became inactive while taking higher doses of intramuscular methotrexate (25mg/week). Side effects occurred in a small number of patients. These side effects were usually mild in nature and included nausea and vomiting, cold symptoms, abdominal pain, headache, joint pain and fatigue. Methotrexate (12.5 to 15mg/week) taken orally was not shown to be an effective treatment for inactive Crohn's disease. * NNT = number needed to treat to benefit 1 individual

Caveat: The 3 studies differed significantly with respect to methodology. Two studies investigated the efficacy of methotrexate compared to placebo. Two studies looked at methotrexate compared to 6-mercaptopurine, and also investigated oral methotrexate compared to 5-ASA. One well-designed trial provided evidence that methotrexate at a dose of 15mg intramuscularly weekly is safe and effective for maintenance of remission in quiescent Crohn's disease. The other 2 studies suggested methotrexate is safe, but failed to show a benefit for lower doses given orally.

Context: Safe and effective long-term treatments that reduce the need for corticosteroids are required for Crohn's disease. Although purine antimetabolites (such as azathioprine and 6-mercaptopurine) are moderately effective for maintenance of remission, patients often relapse despite treatment with these agents. Methotrexate may provide a safe and effective alternative to more expensive maintenance treatment with tumour-necrosis factor-alpha antagonists (such as infliximab).

Cochrane Systematic Review: Patel V et al. Methotrexate for maintenance of remission in Crohn's disease. Cochrane Reviews 2009, Issue 4. Article No. CD006884. DOI: 10.1002/14651858.CD006884.pub2. This review contains 3 studies involving 226 participants.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 227, December 2009.
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: D. Digestive, B. Blood/Immune Mechanisms. Keywords: Crohn's, methotrexate, remission

Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 8 June 2010

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.