Methotrexate is the re-discovered drug for Crohn’s disease
Authors:
M. Lukáš
Authors‘ workplace:
Klinické a výzkumné centrum pro střevní záněty, Klinické centrum ISCARE a. s. a 1. LF UK v Praze
Published in:
Gastroent Hepatol 2024; 78(1): 37-40
Category:
IBD
doi:
https://doi.org/10.48096/ccgh202437
Overview
Methotrexate, the analog of folic acid, was introduced for clinical practice more than 60 years ago being utilized for immune-mediated disorders including also Crohn’s disease. In the difference from rheumatoid arthritis patients, methotrexate in Crohn’s disease patients is used in higher dosages and preferable route of administration is parenteral (subcutaneous) application. Indication for methotrexate therapy is a mild to moderate severity of Crohn’s disease after induction the remission due to topic or systemic corticosteroids therapy. Other indication for methotrexate therapy is concomitant immunosuppressive therapy with anti-TNF drugs. The cotemporary application of methotrexate is associated with higher trough level of infliximab and in less frequent of anti-drugs antibody production. Comparing to thiopurins, methotrexate therapy is associated with lower risk of severe side effects and there is no contraindication to start therapy in those patients with a history of malignancy.
Sources
1. Lukáš M. Konvenční terapie IBD. In: Pokroky v diagnostice a léčbě idiopatických střevních zánětů. Praha: Galén 2019.
2. Herfarth H, Barnes EL,Valentine JF et al. Metotrexat is not superior to maintaining steroid-free response or remission in ulcerative colitis. Gastroenterology 2018; 155(4): 1098–1108. doi: 10.1053/ j.gastro.2018.06.046.
3. Feagan BG, Rochon J, Fedorak RN et al. Methotrexate for the treatment of Crohn’s disease. The North American Crohn’s Study Group Investigators. N Engl J Med 1995; 332: 292–297. doi: 10.1056/ NEJM199502023320503.
4. Qiu Y, Mao R, Chen BL et al. Effect of combination therapy with immunomodulators on trough levels and antibodies against tumor necrosis factor antagonists in patients with inflammatory bowel disease: A meta-analysis. Clin Gastroenterol Hepatol 2017; 15(9): 1359–1372. doi: 10.1016/ j.cgh.2017.02.005.
5. Hirten RP, Iacucci M, Shah S et al. Combining biologics in inflammatory bowel diease and orher immune mediated inflammatory disorders. Clin Gastroenterol Hepatol 2018; 16(9): 1374–1384. doi: 10.1016/ j.cgh.2018.02.024.
6. Feagan BG, McDonald JWD, Panaccione R et al. Methotrexate in combination with infliximab is not more effective than infliximab alone in patients with Crohn’s Disease. Gastroenterology 2014; 146(3): 681–688. doi: 10.1053/ j.gastro.2013.11.024.
7. Colombel JF, Ungaro RC, Sands BC et al. Vedolizumab, adalimumab, and methotrexate combination therapy in Crohn’s disease (EXPLORER). Clin Gastroenterol Hepatol 2023; S1542–3565(23)00746-2. doi: 10.1016/ j.cgh. 2023.09.010.
8. Park J, Chun J, Park SJ et al. Effectiveness and tolerability of methotrexate combined with biologics in patients with Crohn’s disease: A multicenter observational study. Dig Dis Sci 2024. doi: 10.1007/ s10620-023-08237-0.
9. Atia O, Friss Ch, Ledderman N et al. Thiopurines have a longer treatment durability than methotrexate in adults and children with Crohn’s disease. J Crohn’s Colitis 2023; 17(10): 1614–1623. doi: 10.1093/ ecco-jcc/ jjad076.
10. Gomolón F, Dignas A, Vito A et al. 3rd European evidence based consensus on the diagnosis and menagement of Crohn’s disease 2016: Part 1: Diagnosis and medical management. J Crohn’s Colitis 2017; 11(1): 3–25. doi: 10.1093/ ecco-jcc/ jjw168.
11. McDonald JW, Wang Y, Tsoulis DJ et al. Methotrexate for induction of remission in refractory Crohn’s disease. Cochrane Database Syst Rev 2014; 8: CD003459. doi: 10.1002/ 14651858.CD003459.pub4.
12. Nunez P, Quera R, Bay C et al. Drug-induced liver injury used in the treatment of inflammatory bowel disease. J Crohn’s Colitis 2022; 17(7): 1168–1176. doi: 10.1093/ ecco-jcc/ jjac013.
13. Van de Meeberg M, Fidder H, Sundaresan J et al. A higher red blood cell methotrexate polyglutamate 3 concentration is associated with methotrexate-drug survival in patients with Crohn’s disease: First results of a prospective cohort. J Crohn’s Colitis 2023; 17(1): i518–i519, P384.
ORCID autora
M. Lukáš 0000-0002-1463-3840.
Doručeno/ Submitted: 5. 2. 2024
Přijato/ Accepted: 12. 2. 2024
prof. MU Dr. Milan Lukáš, CSc., AGAF
Klinické a výzkumné centrum pro střevní záněty
Klinické centrum ISCARE a.s. a 1. LF UK v Praze
Českomoravská 19
190 00 Praha 9
milan.lukas@email.cz
Labels
Paediatric gastroenterology Gastroenterology and hepatology SurgeryArticle was published in
Gastroenterology and Hepatology
2024 Issue 1
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