Methotrexate: should we start using it in clinical practice?

P. Miheller, Lajos S. Kiss, Michael Mandel, P. Lakatos

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Therapeutic approaches in inflammatory bowel disease have changed significantly in the past decade. Early aggressive immunosuppression has become the mainstay of therapy for patients at risk for complicated disease. Azathioprine is the most widely used immunosuppressant; however, a subgroup of patients is intolerant or refractory. Since the late 1990s, methotrexate (MTX) has become more widely used as an immunomodulator in patients with chronic inflammatory diseases such as rheumatoid arthritis and psoriasis. Yet according to recent clinical data, methotrexate remained the second most commonly used immunosuppressive in inflammatory bowel diseases. Two landmark trials and subsequent studies provided evidence for the use of methotrexate in Crohn's disease, both for induction and maintenance of remission. The evidence is less solid in ulcerative colitis, for which results of further randomized controlled trials are pending (e.g. Meteor, Merit). A potential new indication of MTX could be combination therapy with biologicals. While this is state of the art therapy in rheumatoid arthritis, data in inflammatory bowel diseases are less clear. Some studies suggest that combination with immunosuppressants could prevent the development of anti-drug antibodies, while others suggested anti- TNF induced autoimmune disorders as a potential indication. In contrast, improved efficacy was not reported by one study (COMMIT). Limitations include frequent side effects, route of administration, pregnancy and concerns about long-term safety. This review summarizes current knowledge on the efficacy and side effects of methotrexate, and tries to reevaluate the drug in the current IBD armamentarium.

Original languageEnglish
Pages (from-to)1480-1489
Number of pages10
JournalCurrent Drug Targets
Volume14
Issue number12
Publication statusPublished - Nov 2013

Fingerprint

Methotrexate
Immunosuppressive Agents
Inflammatory Bowel Diseases
Rheumatoid Arthritis
Meteoroids
Art Therapy
Remission Induction
Biological Therapy
Azathioprine
Immunologic Factors
Ulcerative Colitis
Psoriasis
Crohn Disease
Pharmaceutical Preparations
Immunosuppression
Anti-Idiotypic Antibodies
Chronic Disease
Refractory materials
Randomized Controlled Trials
Maintenance

ASJC Scopus subject areas

  • Drug Discovery
  • Pharmacology
  • Clinical Biochemistry
  • Molecular Medicine

Cite this

Methotrexate : should we start using it in clinical practice? / Miheller, P.; Kiss, Lajos S.; Mandel, Michael; Lakatos, P.

In: Current Drug Targets, Vol. 14, No. 12, 11.2013, p. 1480-1489.

Research output: Contribution to journalArticle

Miheller, P. ; Kiss, Lajos S. ; Mandel, Michael ; Lakatos, P. / Methotrexate : should we start using it in clinical practice?. In: Current Drug Targets. 2013 ; Vol. 14, No. 12. pp. 1480-1489.
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