Gastrointestinal Tract - Original Article

Parenteral Methotrexate Is Efficient in the Treatment of Azathioprine Refractory Crohn’s Disease

Volume 33 · Issue 2 Publish Date: February 15, 2022
Volkan Gökbulut Yasemin Özin İsmail Hakkı Kalkan Derya Arı Mahmut Yüksel Zeki Mesut Yalın Kılıç Ertuğrul Kayaçetin
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Turkish Journal of Gastroenterology

Volume 33 · Issue 2

Pages: 111-118

History

Published Online: February 15, 2022

Copyright © 2022 Volkan Gökbulut, Yasemin Özin, İsmail Hakkı Kalkan, Derya Arı, Mahmut Yüksel, Zeki Mesut Yalın Kılıç, Ertuğrul Kayaçetin

Volkan Gökbulut
Department of Gastroenterology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
Yasemin Özin
Departments of Gastroenterology and Pathology, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara
İsmail Hakkı Kalkan
Department of Gastroenterology, Türkiye Yüksek ihtisas Training and Research Hospital, Ankara
Derya Arı
Türkiye Yüksek İhtisas Education Training and Research Hospital, Gastroenterology, Turkey
Mahmut Yüksel
Department of Gastroenterology, Türkiye Yüksek İhtisas University Hospital, Ankara, Turkey
Zeki Mesut Yalın Kılıç
Departments of Gastroenterology and Pathology, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara
Ertuğrul Kayaçetin
Department of Gastroenterology, Ankara Yüksek İhtisas Research and Training Hospital, Ankara, Turkey
Gökbulut, V., Özin, Y., Kalkan, İsmail H., Arı, D., Yüksel, M., Yalın Kılıç, Z. M., & Kayaçetin, E. (2022). Parenteral Methotrexate Is Efficient in the Treatment of Azathioprine Refractory Crohn’s Disease. Turkish Journal of Gastroenterology, 33(2), 111–118. https://doi.org/10.5152/tjg.2022.21459
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Abstract

Background: There is limited data in the literature analyzing the efficacy of methotrexate in Crohn’s disease used after thiopurine analogs. We aimed in our study to show the efficacy of methotrexate in Crohn’s disease patients who failed to respond to thiopurine treatment. Methods: The study included 29 azathioprine refractory patients with Crohn’s disease. Intramuscular methotrexate (25 mg/week) in the induction of remission and intramuscular methotrexate (15 mg/week) in 29 CD patients with a median follow-up time of 13 months was performed. In 15 (51.7%) patients, methotrexate was used in combination with anti-Tumour necrosis factor (TNF) (combination group), while it was used in 14 (48.3%) patients in monotherapy (monotherapy group). Results: The mean Harvey–Bradshaw index score significantly decreased in the follow-up period (Wk0 = 7.6, last visit = 4.5, P < .001). Remission and response rates at week 12 were 75.9% and 79.3%, respectively. Maintenance of remission (77.8% vs 37.5%, respectively, P = .1) and response rates (77.8% vs 50%, respectively, P = .3) due to last visit examination were numerically higher in combination group but they were not statistically significant. The cumulative probability of remission maintenance in patients with methotrexate therapy was 72.7%, 33.1%, and 22.0% at 1, 2 ,and 4 years after starting methotrexate, respectively. Conclusion: Our results show that parenteral use of methotrexate is efficacious in inducing and maintaining remission as a step-up agent in azathioprine refractory Crohn’s disease patients Cite this article as: Gökbulut V, Özin Y, Kalkan İH, et al. Parenteral methotrexate is efficient in the treatment of azathioprine refractory Crohn’s disease. Turk J Gastroenterol. 2022;33(2):111-118.

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Article Info
Published In
Journal Turkish Journal of Gastroenterology
Volume / Issue Volume 33 · Issue 2
Pages 111-118
DOI 10.5152/tjg.2022.21459
History
Published Online February 15, 2022
Copyright
Copyright (c) 2022 Volkan Gökbulut, Yasemin Özin, İsmail Hakkı Kalkan, Derya Arı, Mahmut Yüksel, Zeki Mesut Yalın Kılıç, Ertuğrul Kayaçetin
Affiliations
Volkan Gökbulut
Department of Gastroenterology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
Yasemin Özin
Departments of Gastroenterology and Pathology, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara
İsmail Hakkı Kalkan
Department of Gastroenterology, Türkiye Yüksek ihtisas Training and Research Hospital, Ankara
Derya Arı
Türkiye Yüksek İhtisas Education Training and Research Hospital, Gastroenterology, Turkey
Mahmut Yüksel
Department of Gastroenterology, Türkiye Yüksek İhtisas University Hospital, Ankara, Turkey
Zeki Mesut Yalın Kılıç
Departments of Gastroenterology and Pathology, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara
Ertuğrul Kayaçetin
Department of Gastroenterology, Ankara Yüksek İhtisas Research and Training Hospital, Ankara, Turkey
Cite this Article
Gökbulut, V., Özin, Y., Kalkan, İsmail H., Arı, D., Yüksel, M., Yalın Kılıç, Z. M., & Kayaçetin, E. (2022). Parenteral Methotrexate Is Efficient in the Treatment of Azathioprine Refractory Crohn’s Disease. Turkish Journal of Gastroenterology, 33(2), 111–118. https://doi.org/10.5152/tjg.2022.21459
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