Oral methotrexate in ulcerative colitis

• Published in: Alimentary pharmacology & therapeutics Vol. 21; no. 4; pp. 385 - 389
• Main Authors: Cummings, J. R. F., Herrlinger, K. R., Travis, S. P. L., Gorard, D. A., McIntyre, A. S., Jewell, D. P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 15.02.2005; Blackwell
• Subjects: Adolescent; Adult; Aged; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Azathioprine - adverse effects; Biological and medical sciences; Colitis, Ulcerative - complications; Colitis, Ulcerative - drug therapy; Digestive system; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Agents - adverse effects; Gastrointestinal Agents - therapeutic use; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Male; Medical sciences; Methotrexate - adverse effects; Methotrexate - therapeutic use; Middle Aged; Pharmacology. Drug treatments; Retrospective Studies; Treatment Outcome; Antifolate; Antineoplastic agent; Antimetabolic; Oral administration; Digestive diseases; Intestinal disease; Methotrexate; Inflammatory disease; Ulcerative colitis
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2005.02331.x

Summary Background : We performed an audit of methotrexate for ulcerative colitis, because efficacy is unclear. Aim : To investigate the role of methotrexate in the management of ulcerative colitis. Methods : Patients with ulcerative colitis treated with oral methotrexate at the inflammatory bowel disease clinics of Oxford and Wycombe General Hospital, UK, were evaluated. Efficacy was defined by remission (complete steroid withdrawal for >3 months) and response (good, partial or nil, proportionate reduction of steroids). Results : There were 50 patients (42 ulcerative colitis alone; eight had rheumatoid arthritis associated with ulcerative colitis and were analysed separately). Indications for methotrexate in ulcerative colitis alone were azathioprine intolerance (31 of 42) and lack of benefit from azathioprine (11 of 42). The mean dose of methotrexate in ulcerative colitis alone was 19.9 mg/week for a median of 30 weeks (range: 7–395). Remission occurred in 42%. The response was good in 54% and partial in 18%. Side‐effects occurred in 23%; 10% stopped treatment because of side‐effects. Of those treated with methotrexate because of treatment failure with azathioprine, three of 11 achieved remission, but four came to colectomy within 90 days of starting methotrexate. The colitis remained in remission in seven of eight of those with RA treated with methotrexate and ulcerative colitis (mean dose 15.0 mg/week). Conclusion : Oral methotrexate (approximately 20 mg/week) is well‐tolerated and moderately effective in steroid‐dependent or steroid‐refractory patients with ulcerative colitis.