METHOTREXATE TREATMENT OF IDIOPATHIC GRANULOMATOUS HEPATITIS

Objective: To test the efficacy and safety of low-dose oral pulse meth otrexate therapy in patients with idiopathic granulomatous hepatitis w ho had complications of, did not respond to, or refused glucocorticoid therapy. Design: Prospective case study. Setting: Academic medical ce nter hospital. Patients: Seven patients with biopsy-proven, idiopathic granulomatous hepatitis who could not tolerate or were unresponsive t o glucocorticoid therapy. Intervention: Low-dose oral pulse methotrexa te, 15 mg/wk. Measurements: Temperature, symptoms, dose of concurrent glucocorticoids, biochemical tests of liver function, side effects of methotrexate, and assessment of liver biopsy specimens. Results: All s ix febrile patients became afebrile within 3 months of starting methot rexate. Fatigue and anorexia improved in all patients. Glucocorticoid therapy was successfully discontinued within 6 months of starting meth otrexate in four patients receiving prednisone at entry. Liver biopsy specimens were obtained again after methotrexate therapy and showed ab sence of granulomas in four of four patients. The minimum effective do se of methotrexate was 0.20 mg/kg body weight per week. No serious adv erse effects and no failures to respond to methotrexate therapy were n oted in this group of patients. In three patients, methotrexate therap y has been successfully tapered without signs or symptoms of recurrent disease. Conclusions: Low-dose oral pulse methotrexate was effective in treating patients with granulomatous hepatitis.