METHOTREXATE FOR THE TREATMENT OF REFRACTORY CROHNS-DISEASE

Background: Previous studies suggested that methotrexate has beneficia l effects in patients with Crohn's disease. We report our experience w ith this agent in patients with chronic active Crohn's disease who pre viously failed to improve with conventional treatment, including azath ioprine in most cases. Methods: Between June 1988 and June 1992, 39 pa tients with refractory Crohn's disease were treated with methotrexate. In patients with active disease, clinical remission was defined by a Harvey-Bradshaw index of less than 4. For patients also taking cortico steroids, the dates of remission and complete steroid withdrawal were recorded. For patients who achieved clinical remission, and those in c linical remission when methotrexate was started. the relapse rate on m ethotrexate therapy was noted. Results: In the 37 patients with active disease at methotrexate initiation, the probability of remission was 72% at 3 months. The probability of remission and steroid withdrawal w as 42% at 12 months. In patients on clinical remission, the probabilit y of relapse on methotrexate was 58% at 12 months. Twenty-two patients experienced side-effects, but these only warranted methotrexate disco ntinuation in four cases. Conclusions: Methotrexate appears effective in most patients with refractory Crohn's disease and its shortterm tox icity is acceptable, but the long-term benefit seems more limited.