Effectiveness and tolerability of methotrexate monotherapy in Crohn's disease patients: a multicenter observational study

Jihye Park; Jaeyoung Chun; Soo Jung Park; Jae Jun Park; Tae Il Kim; Hyuk Yoon; Jae Hee Cheon

doi:10.1177/17562848231191664

Effectiveness and tolerability of methotrexate monotherapy in Crohn's disease patients: a multicenter observational study

Therap Adv Gastroenterol. 2023 Aug 23:16:17562848231191664. doi: 10.1177/17562848231191664. eCollection 2023.

Authors

Jihye Park^{1

2}, Jaeyoung Chun³, Soo Jung Park^{1

2}, Jae Jun Park^{1

2}, Tae Il Kim^{1

2}, Hyuk Yoon^{4

5}, Jae Hee Cheon^{6

2}

Affiliations

¹ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
² Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
³ Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
⁴ Department of Internal Medicine, Seoul National University Bundang Hospital, 166 Gumin-ro, Bundang-gu, Seongnam-si, Gyunggi-do 463-707, South Korea.
⁵ Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
⁶ Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.

Abstract

Background: Methotrexate monotherapy is recommended as a maintenance therapy for Crohn's disease (CD). However, long-term follow-up data are scarce.

Objectives: We aimed to examine the effectiveness and tolerability of methotrexate monotherapy in 94 CD patients from three inflammatory bowel disease Clinics in Korea.

Design: This was a multicenter retrospective observational study.

Methods: Patients with active CD treated with methotrexate monotherapy were included. Clinical characteristics, laboratory indicators, endoscopy indices were evaluated at baseline, 6, 12, and 24 months. Independent factors associated with long-term clinical and endoscopic outcomes were determined.

Results: Methotrexate was administered orally (70.2%) or parenterally (29.8%). The mean methotrexate induction dose was 15.3 ± 0.4 mg/week, and the mean duration of therapy was 26.2 months. Of 76 patients who were treated for >6 months, the clinical remission rates were 76.3%, 74.6%, and 80.0% at 6, 12, and 24 months, respectively, by per-protocol analysis. The mean CRP levels were 7.5 ± 1.3, 5.3 ± 1.2, 3.8 ± 0.7, and 2.6 ± 0.5 mg/L at 0, 6, 12, and 24 months, respectively. Of 31 patients who underwent follow-up endoscopy after 27.5 months, the endoscopic remission rate was 38.7%. Baseline hemoglobin level <10 g/dL was a significant independent factor negatively associated with clinical remission at 6 [odds ratio (OR): 0.023, 95% confidence interval (CI): 0.003-0.206, p = 0.001] and 12 (OR: 0.079, 95% CI: 0.009-0.699, p = 0.023) months. Parenteral administration was a significant independent factor positively associated with clinical remission (OR: 11.231, 95% CI: 1.027-122.811, p = 0.047) and endoscopic remission (hazard ratio: 4.711, 95% CI: 1.398-15.874, p = 0.012) at 12 months.

Conclusions: Methotrexate monotherapy was effective and tolerable as a maintenance therapy in CD patients.

Keywords: Crohn’s disease; drug-related side effects and adverse reactions; methotrexate; monotherapy; treatment outcome.