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Evidence summaries

Methotrexate for Induction of Remission in Refractory Crohn's Disease

High dose intramuscular methotrexate may be effective in induction of remission in refractory Crohn's disease. Level of evidence: "C"

A Cochrane review (abstract , review [Abstract]) included 7 studies with a total of 495 patients. The studies differed with respect to participants, intervention, and outcomes to the extent that it was considered to be inappropriate to combine the data statistically. Three small studies which employed low doses of methotrexate orally showed no statistically significant difference between methotrexate and placebo/control medication treated patients. One small study which used a higher dose of intravenous/oral methotrexate showed no statistically significant difference between methotrexate and azathioprine. A larger study which employed a higher dose of methotrexate intramuscularly showed substantial benefit (number needed to treat, NNT=5). Adverse effects were more common with high dose intramuscular methotrexate therapy than with placebo.

Comment: The quality of evidence is downgraded by imprecise results (only one study showed the effect, few patients and wide confidence intervals).

    References

    • :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. [PubMed].

Primary/Secondary Keywords