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Journal of Crohn's and Colitis: 9 (5)


Laurence J. Egan, Ireland

Associate Editors

Maria T. Abreu, USAShomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKGijs van den Brink, NLSéverine Vermeire, Belgium


Published on behalf of

Methotrexate in ulcerative colitis: A Spanish multicentric study on clinical use and efficacy

Míriam Mañosa , Valle García , Luisa Castro , Orlando García-Bosch , María Chaparro , Manuel Barreiro-de Acosta , Daniel Carpio , Mariam Aguas
DOI: http://dx.doi.org/10.1016/j.crohns.2011.03.012 397-401 First published online: 1 October 2011


Background: Few data are available on the efficacy of methotrexate (MTX) in ulcerative colitis (UC).

Aim: To evaluate the efficacy and safety of MTX in UC patients.

Patients and methods: UC patients who had been treated with MTX were identified from the databases of 8 Spanish IBD referral hospitals. Patients were included in the study if they received MTX for steroid dependency or steroid refractoriness. Therapeutic success was defined as the absence of UC-related symptoms, complete steroid withdrawal and no requirement of rescue therapies within the first 6 months after starting MTX.

Results: Forty patients were included, 70% treated for steroid dependency and 27% for steroid refractoriness. Thiopurines had been previously attempted in 87.5% of patients. The median dose of MTX used for induction was 25 mg (IIQ 17.5–25) weekly given parenterally in 82.5% of cases. Eighty-five percent of patients were on steroids when MTX was started. Forty-five percent of patients met criteria for therapeutic success. Initial treatment failures were mainly due to inefficacy (50%) or intolerance (36%). After a median follow-up of 28 months (IQR 22–47), 38% of patients with initial therapeutic success required new steroid courses, 22% started biological therapy, and only 1 patient required colectomy. The cumulative probability of maintaining steroid-free clinical remission was 60%, 48%, and 35% at 6, 12, and 24 months after starting MTX, respectively. Eleven patients (27.5%) experienced adverse events, leading to MTX discontinuation in only 8 of them.

Conclusions: MTX appears to be effective to maintain clinical remission in UC, at least in the short-term, with an acceptable safety profile.

  • Inflammatory bowel disease
  • Ulcerative colitis
  • Methotrexate
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