How effective is methotrexate for maintenance of remission in Crohn's disease?
The 3 studies differed significantly with respect to methodology. Two studies investigated the efficacy of methotrexate compared to placebo. Two studies looked at methotrexate compared to 6-mercaptopurine, and also investigated oral methotrexate compared to 5-ASA. One well-designed trial provided evidence that methotrexate at a dose of 15mg intramuscularly weekly is safe and effective for maintenance of remission in quiescent Crohn's disease. The other 2 studies suggested methotrexate is safe, but failed to show a benefit for lower doses given orally.
Safe and effective long-term treatments that reduce the need for corticosteroids are required for Crohn's disease. Although purine antimetabolites (such as azathioprine and 6-mercaptopurine) are moderately effective for maintenance of remission, patients often relapse despite treatment with these agents. Methotrexate may provide a safe and effective alternative to more expensive maintenance treatment with tumour-necrosis factor-α antagonists (such as infliximab).